Manager - Physician Services Coding at MaineHealth in Sanford, Maine

Job Description:

Summary

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  Position Summary
  
  
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    This position manages SMHC Physician Services Coding which team(s) isresponsible for coding and abstracting the medical records of professional charges/services for inpatients, ambulatory surgery, and observation; and the facility/professional coding and abstracting of provider based and non-provider based physician practices of Southern Maine Health Care (SMHC). In addition, this position is responsible for preparing statistical analysis of medical records data; compiling, analyzing and summarizing data from medical records into various formats; managing and validating workflows and building positive working relationships with Maine Medical Center Physician Billing and SMHC Physician Practice Leaders and providers. The position also supervises Physician Coding staff. The position and coordinates and collaborates with Physician Coding Auditor and Educator, Revenue Integrity Analysts and Ambulatory Clinical Documentation Improvement team members to ensure timely and accurate chart reviews, validation of charges and documentation, and E & M audits. The Physician Services Coding Manager provides information and reports to fulfill requests made by members of the medial staff, administration and planning.
    
  
  
  
  


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  Required Minimum Knowledge, Skills, and Abilities (KSAs)
  
  
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    Education: Advanced education which should include: communication and mathematical/statistical skills and/or extensive knowledge in organization, research and analysis normally acquired through the completion of Health Record Administration/Science Bachelor's program with certification as an RHIA and coding credentials (CCS, CPC). Credentials are strongly preferred. RHIT may be substituted for RHIA credentials provided held in conjunction with CCS and CPC certifications. Additional experience can be substituted for education above and beyond minimum experience requirements.
    
  
  
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    License/Certifications: Current Coding certification such as CPC, CPMA, CCS-P, RHIT or other comparable cortication. Preferred Current coding certifications for ICD 10. Skilled in ICD-10 coding.
    
  
  
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    Full working knowledge of: physician practice coding, provider based coding and revenue cycle systems; State, Federal and JCAHO requirements pertaining to hospital provider based practices ; various reimbursement and payment systems.
    
  
  
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    Experience: Experienced with EPIC preferred. Previous experience with encoders, claim edit processes, 3M encoder and CDI programs strongly preferred. A minimum of (4) four years' prior successful supervisory/leadership experience. Minimum of four (4) years of coding experience, revenue cycle or physician practice operations experience.
    
  
  
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    Demonstrated abilities to: correctly interpret and apply Federal regulations, requirements in the assignment of E & M; APCs and in the interpretation of various billing guidelines (i.e., medical necessity, resident supervision policies, correct coding initiative, etc.), modifier and place of service code assignments, HCPC & CPT use ; LCD/NCD and other coverage limitations; and provider based practice requirements. Ability to direct pre-bill, concurrent and retrospective coding reviews and successfully provide physician education of opportunities and other regulatory changes as identified.
    
  
  
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    Effective skills in leadership, communications, coaching, problem solving, planning, motivation, and establishing effective working relationships at all levels of staffing in the organization.
    
  
  
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    Proficiency in Microsoft Office including PowerPoint, Excel, Word, Outlook, email.
    
  
  
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    Understanding of MACRA, Risk Adjusted Coding, NCCI, HHC and other clinical documentation improvement protocols and regulations.