Primary City/State: Phoenix, Arizona
Department Name: Coding Ambulatory
Work Shift: Day
Job Category: Revenue Cycle
Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you’ll find many options for contributing to our award-winning patient care.
POSITION SUMMARY
This position plans, leads and directs designated medical coding teams across multiple locations. The position has shared responsibility to achieve the business unit goals in targeted areas such as unbilled accounts receivable, compliance with regulatory requirements, data integrity, Case Mix Index (CMI) and reimbursement with third party payors. The position works collaboratively with Health Information Management System (HIMS) leadership to achieve designated financial and revenue cycle goals and coding compliance.
CORE FUNCTIONS
1. Selects, trains, coaches, motivates, conducts performance evaluations, and directs the workflow for staff assigned to coding function. Develops goals and performance expectations for staff in targeted areas, such as unbilled accounts receivable, quality and timeliness of clinical coding assignments, data integrity and reimbursement with third party payors. Provides for the education, development and shared leadership of staff.
2. Participates in the development of the department budget in conjunction with established goals and objectives. Plays a key role in ensuring budgetary goals are met on an annual basis.
3. Drives organization performance improvements by refinement and monitoring of the coding scorecard which includes: unbilled A/R; Medicare second reviews; RAC denials; first time submission acceptance for the state; coding accuracy; % clean claims; staff stats; etc. Participates in the improvement of processes and programs.
4. Works collaboratively with other leaders to establish coding quality, productivity and best practices. Monitors goals and benchmarks productivity and quality standards in conjunction with industry trends. Identifies potential improvements and moves team to achieve next level of performance with regards to coding quality, productivity and best practices.
5. Participates in developing standard coding policies/procedures/guidelines to ensure compliance with federal, state and local regulatory guidelines to minimize risk for the organization. Supports coding infrastructure to ensure regulatory compliance in all aspects of coding and abstracting of clinical data to support patient care processes.
6. Monitors data integrity on regular basis to ensure abstracted data elements meet requirements, performs staff training and education, communicates with associated departments including semi-annual data submission to state health departments. Supports software testing by providing staff to ensure proper functionality of applications when requested.
7. Keeps abreast of new medical technologies, procedures and pending regulatory changes which impact the organization. Proactively analyzes potential impact to the organization to minimize adverse impact. Participates as a key member for ICD-10 planning and implementation.
8. Position oversees coding for a designed coding team and is responsible for ensuring compliance with regulatory requirements, coding accuracy, data integrity and/or complete and appropriate reimbursement from third party payors. The coding will withstand the scrutiny of internal and/or external reviews. This position works collaboratively with other HIMS leaders as well as corporate and facility leadership. External customers include patients, third party payors, coding related vendors, medical staff.
MINIMUM QUALIFICATIONS
Must possess a strong knowledge of business and/or healthcare as normally obtained through the completion of a bachelor’s degree in business, health care administration or related field.
In the acute care environment, requires a Registered Health Information Administrator (RHIA), Registered Health Information Technologist (RHIT) or Certified Coding Specialist (CCS) in an active status with American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC). In the ambulatory setting, requires Certified Professional Coder (CPC) certification or Certified Coding Specialist-Physician (CCS-P), with RHIA, RHIT or CCS certification preferred.
Must possess a strong knowledge and background in coding as normally demonstrated through three or more years of progressive coding leadership experience preferably within a major health care organization or health system setting. Must have highly developed interpersonal skills and the ability to work collaboratively. Requires the ability to work effectively with all common office software and coding software applications.
Must possess a thorough knowledge of computer applications and their applicability to coding.
PREFERRED QUALIFICATIONS
Additional related education and/or experience preferred.
Banner Health
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