Manager Billing Coding and Denials

Manager Billing Coding and Denials

Are you looking for a rewarding career with family-friendly hours and top-notch benefits? We’re looking for qualified candidates like you to join our Texas Health family.

Work location\: Texas Health Resources-Fully remote but some onsite meetings will be required. Only the approved states below are acceptable for fully remote:

APPROVED REMOTE WORK STATES

AR

FL

GA

MO

NC

OK

TN

TX

UT

Core work hours\: Monday-Friday 8\:00a-5\:00p

Summary

The Billing, Coding & Denials Manager will oversee all aspects of claim review and coding denials management for all THR providers and specialties. In collaboration with key stakeholders, the Manager will create organizational strategies for resolving emerging denial trends that include analyzing, creating, refining workflows and developing policies. The Manager will have direct management responsibilities for related Coding and Reimbursement Department Billing Specialists, Coders and Denial Leads. The Manager will also be an EPIC Access and Revenue Cycle Readiness (ARCR) subject matter expert. The Manager will serve as a lead communicator and educator for staff and providers regarding information and feedback related to coding denials.

Job Duties

Manage Claims/Denials department and staff\:

Analyze, create and refine department work-flows, processes and systems to ensure maximum efficiency, productivity and accuracy.

Monitor WQs, dashboards and reports to ensure performance metrics and quality standards are met.

Report on adherence to key departmental metrics. Establish process improvement as needed to achieve metrics

Manage Internal audit functions:

Ensure compliance with external agencies as related to coding and billing.

Ensure billing and coding accuracy of THOP/THPG staff and external billing partners

Reporting on above initiatives provided to CRD Director monthly

Epic ARCR for Overall Revenue Cycle/ subject matter expert:

Manage high priority issues raised related to build, system and workflows in association with Epic team, External billing partners and

THPG clinics. Identify gaps and risks in order to mitigate.

Participate in meetings and decisions related to optimizing EPIC build, workflows and processes

Monitor the overall revenue cycle dashboard to mitigate financial risk

Establish accountability and escalation paths

Verify ownership and escalation paths for each work queue

Establish/monitor thresholds for key performance indicators

Communicate workflow changes identified through revenue management to the training team; Train key stakeholders on operational

guidelines workflow changes

Conduct demo validation to insure system is configured per build criteria

Responsible for collaborating with other Access Revenue Cycle Readiness leads to ensure organizational success

Provider Feedback and Reporting

Prepare provider reporting and communications to address issues identified and support improved provider documentation and optimal

coding

Provide/Oversee feedback and education to CRD staff, clinics and providers related to issues identified with root cause analysis of the

denials and appeals process

Manage/Troubleshooting for high priority clinics as assigned by CRD Director

Identify and resolve coding, billing, charge reconciliation and build issues

Refine workflows, improve communication and build collaborative relationships with key stakeholders and providers

Manage associated denials staff

Manage external payor escalation functions

Oversee payor requests for records

Participate in Joint Operations Committee meetings and escalate Coding & Reimbursement issues

Facilitate or participate in designated meetings by preparing documentation and communicating updates

Education

Bachelor's Degree HIM or related field required. Or, 4 additional years relevant experience in lieu of a degree is required

Experience

5 years coding and charge capture for physician professional coding and billing required

3 years managing a team required

3 years Accounts Receivable / Denial Management experience required

Licenses and Certifications (Any of the two certifications are required upon hire)

CCS-P - Certified Coding Specialist-Physician based

CPC - Certified Professional Coder

CPB - Certified Professional Billing preferred upon hire

Cardiology, Orthopedic Surgery, OB/Gyn or General Surgery preferred upon hire

Skills

Extensive knowledge of fee schedule functions for professional billing as well as correct coding principles for CPT, ICD, HCPCS Level II coding systems & third party billing regulations

Extensive knowledge of physician practices operations, charge capture, revenue cycle and CMS regulations.

Must possess excellent written & verbal communication skills and be able to facilitate conversations with internal & external customers

Must be detail oriented and have excellent organizational, analytical, research & reporting skills.

Must possess a strong work ethic and a high level of professionalism.

Must have advanced computer skills, with the ability to learn internal application systems. (e.g., Excel, Power Point, Word, Outlook, OneNote, SharePoint)

Must possess strong knowledge of professional billing information systems (Epic preferred)

Why Texas Health?

At Texas Health Resources, our mission is “to improve the health of the people in the communities we serve”.

As part of the Texas Health family and its 28,000+ employees, we’re one of the largest employers in the Dallas Fort Worth area. Our career growth and professional development opportunities are top-notch and our benefits are equally outstanding. Come be a part of our exceptional team as we improve the health of the people in our communities every day. You belong here.

Learn more about our culture, benefits, and recent awards.

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