Job Summary:
Provides leadership for either professional fee and facility-based ambulatory coding auditors/educators within Adventist Health. Leads the implementation and facilitation of ongoing coding audits, reporting, and coding education for ambulatory coding teams, vendor coding teams, and other external/internal stakeholders as needed. Manage projects and initiatives related to ensuring coding integrity and maintaining the highest degree of coding accuracy, documentation integrity, charge capture accuracy and regulatory compliance across ambulatory settings. Supervises and directs the activities of various levels of assigned personnel utilizing both professional and supervisory discretion and independent judgment. Manages and coordinates adherence to the Coding Quality Review Workplan for Acute or Ambulatory Coding. Performs trending and root cause analysis through data review to direct efforts for targeted review, provider feedback, coder education, and process improvement initiatives. Ensures compliance with all applicable federal, state and local regulations, as well as with institutional/organizational standards, practices, coding policies and procedures. Supports revenue cycle compliance program by adhering to policies and procedures pertaining to HIPAA, FDCPA, FCRA, (not related to profee) and other laws applicable to business practices. Leads a team that fosters collaboration, focusing on continuous improvement and alignment with long term strategy goals of Adventist Health.
Job Requirements:
Education and Work Experience:
- Bachelor's degree or equivalent combination of education/experience: Required
- Master's degree: Preferred
- Five years' of hospital-based coding or Five years of professional fee coding experience: Required
- Two years' leadership experience: Required
- Three years of previous coding audit experience: Preferred
Licenses/Certifications:
- Certified Coding Specialist credential through AHIMA (CCS) or Certified Professional Coder (CPC) through AAPC, CPMA certification preferred: Required
- Current permanent U.S. work authorization: Required
Essential Functions:
- Manages the CQR audit/education team to ensure all regularly scheduled and ad hoc quality reviews are completed, in addition to all other team's daily responsibilities. Ensures all coding education needs are being addressed by coordinating education initiatives to internal and external teams, as well as providing oversight for coding education library and resource materials.
- Oversees the audit appeal process to ensure the integrity and accuracy of all coding reviews. Manages respective team to ensure assigned Key Performance Indicators are met. Ensures all CQR team members maintain up-to-date knowledge of medical terminology, coding guidelines, quality standards, regulatory changes, etc. that affect the audit process.
- Develops, recommends, and oversees the implementation and administration of policies and procedures of respective area. Evaluates process and procedures and coordinates with the leadership team to ensure efficient areas of focus and adhere to federal and local laws and regulations.
- Demonstrates, through plans and actions, a consistent standard of excellence to which all department work is expected to conform. Works with cross-functional team members to identify and solve process issues. Focuses on continuous improvement working with the leaders across the health system with a goal of delivering the highest degree of quality service possible.
- Conducts recurring quality assurance audits and provides coaching sessions/performance reviews in relation to set benchmarks. Completes, reviews, manages and monitors department budget.
- Performs other job-related duties as assigned.
Organizational Requirements:
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
