Director of Clinical Coding

Rochester Regional Health Systems   •  

Rochester, NY

Industry: Healthcare

  •  

Not Specified years

Posted 38 days ago

Cognisight, LLC, is a wholly-owned subsidiary of the greater Rochester Independent Practice Association (GRIPA). GRIPA is an IPA/Accountable Care Organization owned equally by the ~1,500 private and employed primary and specialty physicians and Rochester Regional Health serving the Greater Rochester NY area. We are committed to improving the health care quality of our client’s members and meeting the changing demands of risk adjusted reimbursement. We offer competitive wages, 401k plan, excellent health benefits and paid vacation time.

The Director of Clinical Coding leads the coding department for Medicare Advantage, PACE, Commercial, and Medicaid Managed Careproduct lines. Cognisight enters into a contractual agreement with a Plan/Issuer, ACO, or IPA and assists these plans in the identification, capture, and verification of risk adjustment diagnoses.

Requirements

Full Time Days; occasional weekends during peak periods

  • 85% Management and QA responsibilities
  • 15% Medical Record Review

    A successful candidate must possess:

    Health Information Management and Coding Certification(s)/Certified Professional Coder with 10+ years of a combination of coding and management experience. CPC and/or CRC, and RHIT/RHIA and required.  

    In addition, the following is required:

  • HCC & ICD-10 coding experience in Medicare Advantage, PACE, Commercial & Medicaid Managed Carerisk adjustment models
  • Leadership experience managing staff and work processes
  • Ability to communicate and present to clients and providers
  • Ability to present at health field industry conferences as a subject matter expert in coding related topics

    Candidate must be able to:

  • Define coding department work plan as aligned to Cognisight’s strategic plan and services; operationalize, report progress, and identify gap closing support requirements
  • Participate on the leadership team and represent the coding department
  • Provide Cognisight leadership team with enhancements required in product development
  • Provide clinical intellect and expertise to system analytics via project assignment as well as on an ad hoc basis
  • Collaborative input to Cognisight policy and procedure development & updates
  • Develop and monitor resource plan - Hire/Train/Manage/Direct all Lead Coders and Coding Liaisons
  • Work with our contracted vendors to bring on per diemcontracted reviewers for our peak coding periods.
  • Monitor/Manage the work load for all reviewers with assistance from Lead Coders. Work with Director of Account Management and Operations Team to prioritize the work load
  • Through the lead coding trainer, continually educate Clinical Staff (internal &contracted) on ourinternal coding guidelines
    • Assist Lead Coders in creating and maintaining training documents
    • Develop and maintain detailed internal coding guidelines to be in sync with the CMS and ICD10 coding guidelines etc.
  • Through the lead coders, help develop goals and progressreporting for  all coders (internal &contracted)
    • Monitor the productivity and quality of all coders and act as necessary with lead coders
  • Lead client engagement related to Coding information
    • Create and conduct provider and coder training for clients when necessary (via on-site and webinars)
    • Participate in client meetings when necessary (via on-site and webinars) and take the lead when coding is the subject
  • Attend conferences and present on coding subject matters when necessary
  • Review records as time allows, to maintain coding skills and knowledge- 15% of time
  • Ensure coding staff adheres to:

•     Workflows, requirements and timelines of client

•     CMS/HHS/State guidelines

•     DOH guidelines

•     HIPAA, HiTech, & Fraud, Waste, & Abuse regulations

•     All required coding guidelines

•     Keeping all coding credentials current

 Attributes- Ability to:

  • Lead and work within a high functioning team including many interdependencies and work flows
  • Communicate and resolve questions timely and efficiently
  • Use a variety of software tools and reporting
  • Travel when required (~20%)
  • Understand, respect, and apply client specific guidelines
  • Navigate various EMR systems.