Manager of Professional Coding Validation

SUMMARY:

Under the direction of the Director of the Physician Revenue Cycle, the Manager of Coding Policy and Education researches coding and documentation guidelines, payer policies, LCD's and other relevant information to assure that Brown University Health is compliant in its documentation, coding and billing practices. The Manager will develop Brown University Health education/training materials, work with the administrative assistant to publish materials online and update materials as needed. The Manager will work closely with the PFS Manager responsible for Coding Validation, Ambulatory Coding leadership, Compliance, Contracting, providers and others. The Manager will act as a coding and documentation resource for other departments (i.e. IS, practices, etc.) as needed. The Manager of Coding Policy and Education will provide education to providers and work with the Director of the Physician Revenue Cycle, the Director of Ambulatory Coding and the PFS Manager in charge of the validators to develop education plans for coders and validators.
Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect and Excellence, as these values guide our everyday actions with patients, customers and one another.

RESPONSIBILITIES:

• Creates/updates Brown University Health coding, billing and documentation policies. Researches coding, billing and documentation guidelines from reliable sources, collects relevant information and compiles that information into a user-friendly manual to be approved by Director of Physician Revenue Cycle, Compliance and physician leadership before publishing and distributing.

• Hires, coaches and motivates team; determines appropriate and effective performance metrics and staff requirements for the department to run with efficiency, accuracy and outstanding customer service.

• Implements and monitors staff productivity and service performance metrics. Oversees and manages the daily performance of direct reports.

• Develops and implements team's administrative policies and procedures. Assures consistent application of policies.

• Works with the PFS Manager in charge of the validators to develop a schedule of internal audits and audit processes that will assess individual providers' adherence to coding guidelines.

• Provide feedback to Physician Revenue Cycle leadership, the providers, Corporate Compliance, practice leaders and others. Work with the PFS Managers in charge of Denials and Receivables Management to assure that any identified coding/billing errors are corrected with the payers.

• Creates all components of a successful education process, including lesson planning and materials used for educational purposes (i.e. audiovisual aids, Epic Tips sheets, knowledge retention exams, etc.).

• Assists with educating validators/coders as requested. Creates and records various training materials for coders and providers and works with Administrative Assistant to publish recorded materials on the Brown University Health Intranet. Updates documents as needed. Prepares for and conducts provider education sessions (individual and/or group) which include specialty specific coding and documentation guidelines, examples of relevant medical records, resource materials, etc.

• Responsible to assure that review/verification of audit results provided by Corporate Compliance is performed within the timeframe indicated and estimated net adjustments are calculated and returned.

• The Manager is also responsible to assure the completed logs are stored and easily accessible, if requested. Identifies external coinsuring experts to assist with audits of complex specialties and validator education. The Manager will, with Director approval, coordinate learning opportunities and external audits. The latter may include working with IS to obtain security clearance for the vendor, preparing medical records, analyzing results and arranging feedback sessions.

• The Manager of Coding Policy and Education will also work closely with the manager of the Validators to assure follow-up audits are performed and results are tracked.

• Tracks internal and external audits and records results on detailed log. Performs analysis of reports on key coding auditing metrics. Identifies trends and reports those trends to the Director. Assists Director with ROI analyses. Stays abreast of all coding updates, including new/deleted ICD-10 codes, new/deleted CPT codes, new/deleted HCPCS codes and any coding guideline changes.

• Reviews payer updates and notifies Manager of any pertinent changes impacting coding/documentation. Works with the PFS Senior Applications Analyst to obtain list of codes used by each specialty to ensure educational material is all encompassing.

• Promotes a team-oriented environment that fosters effective collaboration within and outside of the department. Assists physician group in establishment of policies relating to documentation and coding.

• Assists in design, implementation and optimization of Epic, making recommendations for changes as necessary.

• Plays a significant role in long-term planning, including initiatives geared toward operational excellence. Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and the American Association of Professional Coders.

• Reports any areas of concern to the Director and works with the Director, Manager of the validators, Director of Ambulatory Coding, Compliance and Practice leadership as necessary. Maintains confidentiality of sensitive information at all times. Participates in various committees, task forces and quality improvement teams as needed. Performs other duties as necessary.

MINIMUM QUALIFICATIONS:

• Associate's Degree in Business, Medical Billing or equivalent experience. Bachelor's degree or equivalent work experience with demonstrated results.

• Certification required: CCS, CPC. RHIA or RHIT considered. Excellent verbal and written communication skills with technical proficiencies to include Microsoft Excel &PowerPoint, and Teams applications.

• EXPERIENCE:

• Minimum of 5 years related experience and/or training, and 2 years related management experience, with experience within a large integrated healthcare delivery system preferred. Epic experience highly desired. Broad knowledge in business administration, finance and healthcare administration. Thorough knowledge of third party commercial and governmental billing. High level of organizational and interpersonal skills to interact with Senior Management on matters having multiple and varying impact on department financial objectives and to respond effectively to competing needs for resources. Managerial skills to develop and supervise department support staff.

• INDEPENDENT ACTION:Performs independently within the department's policies and procedures. Refers specific complex problems to the Manager when clarification of the departmental policies and procedures are required. Must be able to work with minimal supervision.

• WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS

• :Work is performed in a typical office environment requiring extended periods of sitting, standing and walking.span lang=FR font-size: 12ptRemote work from home possible. INDEPENDENT ACTION: Incumbent acts independently and in accordance with policies and procedures, referring unusual problems to the Director. SUPERVISORY RESPONSIBILITY: Supervises up to 50 FTEs.

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EEO Statement:

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

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