Coding Director (Remote)

Job Description

***Remote Position. Candidates living in the Southeast region will be considered

Essential Duties:

Provide leadership to coding review and charge capture staff. Ensure that equity of workloads, productivity goals and assignments are maintained. Assigns monthly benchmarks, weekly activities and daily priorities as appropriate to ensure timely completion of duties

Establish protocols to ensure Revenue Integrity

Plan and direct audits to evaluate the adequacy and accuracy of documentation in support of services billed, including CPT/ICD-10/HCPCS and other third-party payer codes, medical necessity of services, compliance with other documentation and coding and billing standards

Lead the evaluation of the adequacy and effectiveness of internal and operational controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements and guidelines related to coding and billing, federal and state regulations and guidelines, CMS and other third-party payer billing rules, and OIG compliance standards

Establish and implement a physician education program to include documentation education

Serve as a subject matter expert and authoritative resource on interpretation and application of documentation and coding rules and regulations, and conduct enterprise risk assessments of potential and detected compliance deficiencies

Stay current on relevant coding and billing regulations and enforcement trends, specifically as they relate to provider-based coding and billing to include updates to key stakeholders

Develop standards and guidelines for medical record documentation including reporting on deficiencies and training to remediate

Collaborate with Compliance Officer on compliance, coding documentation and risk management when required

Develop the annual compliance work plan sections relating to coding and billing

Work closely with company’s physicians, Operations and Revenue Cycle Leadership to validate controls and monitor high risk areas

Perform coding and billing documentation and charge audits, according to best practices

Responsible for coaching, professional development, and mentoring coding and data entry staff

Develop documented policies and processes related to the management of coding and billing compliance matters

Develop edits within claims scrubber EHR software including testing and validation

Prepare and provide coding education to organization physicians, providers and staff

Responsible for effective identification of staffing resources, recruitment and allocation of resources

Provide guidance and motivation to staff regarding identification of activities/areas where performance can be improved

Responsible for making recommendations and/or decisions for hiring, corrective actions, terminations, and performance evaluations

Other duties as assigned by the Vice President of Revenue Cycle Management

Required Qualifications:

Certified Professional Coder- AAPC Certifications

Coding compliance experience

Bachelor’s degree or equivalent work experience

Orthopedic physician practice and/or surgery center experience

Advanced Knowledge of:

Documentation, coding and billing rules/guidelines

CPT/ICD-10/HCPCS coding rules

Medical terminology and healthcare compliance audit requirements

CMS regulations and guidelines

Minimum of 10+ years of management experience in a physician or healthcare MSO organization

Ability to manage and direct others in a fast-paced, team-oriented environment including remote indirect and direct reports

Independent judgment; effective, team-oriented leadership skills.

Excellent analytical, problem-solving and decision-making skills

Excellent communication skills (verbal, written & presentation)

Excellent computer skills with strong proficiency in reporting, spreadsheet applications and experience with Microsoft Office

Travel up to 25% as needed for practice support, coding audits, learning and development, coding team member coaching, etc.

Preferred Qualifications:

Certified Orthopedic Surgery Coder

Physical Requirements:

Physical requirements for the position include the ability to frequently hear and communicate orally, see up close and at a distance, read and comprehend, stand, sit, walk, reach, handle, and/or feel objects. Must be able to climb, pull, push and kneel. Maximum unassisted lift = 25 lbs. Average lift less than 10 lbs. Must be able to work extended hours as necessary.

Full-time

Fully remote