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Director of Professional Coding


Company

Lancaster General Medical Grp

Cost Center

61477 Balance Sheet Posting - Coding Services

Supervisory Organization

Professional Billing Services- Leadership

Grade

G19

Summary

POSITION SUMMARY:

The Director of Professional Coding is responsible directly or indirectly for coding issues, coding education, coding auditing, reimbursement, and appropriate coding compliance within Physician Services while adhering to official coding guidelines. The Director of Professional Coding will provide leadership and direction, counsel and educate employees, identify problems, and report findings and recommendations to the VP Finance-Physician Services.  The Director of Professional Coding is responsible for optimizing coding, reimbursement, coding education and compliance throughout Physician Services and all of its practices. The Director of Professional Coding reports to the VP Operations-LGHP Specialty Physician Services.

ESSENTIAL FUNCTIONS:

  • Responsible for direct supervision, management and mentorship of Manager of Professional Coding and Coding staff, including design, and oversight of all initial and follow up inpatient and outpatient coding reviews, work que management, as well as educational and coding review efforts.
  • Responsible for indirect supervision and mentor and act as a coding educational resource for, Physician practices that do not fall directly under Physicians Services. These include design, and oversight of all initial and follow up inpatient and outpatient coding reviews, work que management, as well as educational and coding review efforts.
  • Serve as a professional coding/ revenue cycle resource for providers and staff at Physician Services practices and Patient Financial Services; Research coding, reimbursement for services, billing, and payor guidelines.
  • Annually, develop coding education program for providers and coding staff based on internal assessments and external factors/trends.  Prepare and present specific coding education as required.  Coordinate use of subject matter experts as necessary.
  • Establish and maintain coding review program, including (but not limited to) new providers to Physician Services, sites/offices new to Physician Services, new or “high-risk” procedures, etc.  Perform medical record reviews as necessary. Reviews work product for completeness, accuracy, and coherency. Submit periodic reports to the VP Finance-Physicians Services for review and approval.
  • Analyze data to determine areas of high risk and target these areas for further review and analysis.
  • Validate all coding changes recommended by pre and post payment review auditors, commercial insurers, or Medicare/Medicaid and prepare appeals as necessary. .   Relate the circumstances of denials to the appropriate parties.
  • Review, track, and trend problem areas that arise (incorrect coding, PBS/PFS problems, or documentation questions) and recommend a plan of action to resolve these problems and communicate with the appropriate personnel and the VP, Operations.
  • Establish reporting mechanisms to review practice distribution curves and share as necessary with each provider in a timely, meaningful manner.  Optimize revenue through utilization of most appropriate coding methods.                           
  • Coordinate Physician Services response to payor audits in conjunction with the Corporate Compliance department.
  • Supervise Manager and coding staff and facilitate staff development and job satisfaction.  Establish mechanism/structure to allocate work functions among staff.
  • Assist Physician Services practices and Patient Financial Services with coding and medical necessity denials; monitor and manage coding-related work queues.
  • Support Physicians Services and LGHealth endeavors such as PQRS, eRX, meaningful use, Quality payments for payors, patient centered medical home, Accountable Care Organizations etc.
  • Research and Investigate in a timely manner, new revenue opportunities.
  • Facilitate provider and staff training on ICD-10, HCCs or other coding training
  • Work with providers and IT staff on EPIC functionality to create automated methods of charting and billing for efficiency.
  • Work on a plan for recruiting and retaining coding personnel.
  • Work closely with the Director of Revenue cycle and the Professional Billing Services department to maximize the performance of the revenue cycle.

MINIMUM QUALIFICATIONS:

  • Bachelors Degree
  • Formal education in ICD-10-CM coding, CPT-4 coding, and medical terminology.
  • Certification as a Certified Coding Specialist for Physicians (CCS-P) or Certified Professional Coder (CPC).
  • Ten (10) years of ICD-10-CM coding experience
  • Ten (10) years of CPT-4 coding experience
  • A health care provider in good standing with Medicare, Medicaid, and other federal and state health insurance programs, i.e. not excluded from participation in Medicare, Medicaid or any other federal or state health insurance program.
  • Master’s Degree preferred
  • Three (3) year experience with Epic or related software preferred
  • Ten (10) years experience with physician offices preferred

BURLE Full Time Posted on 08/27/2019