The Coding Compliance Supervisor responsible for supervising and supporting the Coding Compliance team. This oversight includes providing educational training for both internal and external customers, developing tools for physicians, and ensuring the accuracy, consistency, and efficiency of coding processes. The Coding Compliance Supervisor is also responsible for identifying, developing, and implementing opportunities for staff development, as well as regularly evaluating the team’s performance towards key performance indicators, and providing regular, meaningful feedback to ensure success. Lastly, the Coding Compliance Supervisor is expected to evaluate existing internal procedures and workflows to identify, develop, and implement new procedures to improve coding/billing processes.
Essential Functions and Responsibilities of the Job
Supervise Coding staff, ensuring high levels of engagement and effective communication
Work with Coding leadership to establish, monitor, and report productivity and quality standards
Supervise the activity in the Epic work queues to ensure appropriate assignments across the Coding staff and identify opportunities for workflow optimization
Review and analyze patient medical records in EMR. Ensure the records have been appropriately coded using CPT, ICD-10, and HCPCS in accordance with CMS and health plans’ billing guidelines.
Monitor the performance of Coding Staff and perform ongoing feedback to promote the team’s growth and development
Prepare and present educational content to physicians and their staff
Perform technical research and prepare best practices and policy documents based on coding compliance guidelines
Be at work and be on time
Follow company policies, procedures and directives
Interact in a positive and constructive manner
Essential Job Outcomes
Overall supervision of coder daily activities and monitoring the coding work queues. Inspire the trust and respect of the team and help increase coder productivity and quality through on-going education and support, motivating the team to achieve both department and organizational goals. Recognize the different skill sets of team members and utilize their strengths for the benefit of the team. Support Coding Compliance Manager and be a 'change champion' to help the Coding Compliance team be successful, leading by example.
Monitor the coder's productivity and ensure that the coders are following established coding guidelines in adherence with standard work. Measurement will be based on the Coding Team's annual average productivity score.
Monitor the coder's quality and provide individualized coder support and education as needed to ensure that the coders are following established coding guidelines in adherence with standard work. Measurement will be based on the Coding Team's annual average quality score.
In adherence with standard work, conduct audit QA and provide ongoing education to MCMF physicians and coders to maximize compliance and reimbursement.
In adherence with standard work, follow Coding Compliance department standards and branding when communicating with clinical partners and fellow business center teams. Create branded communication with Coding Manager in Coding Communication Workgroup. Work collaboratively to solve billing and coding issues with Physician Billing Services Insurance and Customer Service Representatives.
Employ strong understanding of the encounter/billing process and working knowledge of Medicare, Commercial, and HMO insurance, including the impact on reimbursement. Utilize medical reference resources and contacts to thoroughly research coding issues and maintain working knowledge of payment/reimbursement systems to ensure maximum reimbursement and coding compliance.
In adherence with standard work, identify opportunities for billing/coding improvements. Participate in developing, implementing, and reviewing programs for coding compliance monitoring, criteria for benchmark comparisons, organizational policies and procedures, and physician clinical documentation improvement programs. Optimization opportunities include, but not limited to, supporting the coders in their optimization efforts and analyzing coding denial trends.
In adherence with standard work, take responsibility for various projects as assigned by management, and perform any additional/miscellaneous duties (not inclusive of job description) as requested by the management team within the scope of knowledge/ability.
“Other duties as assigned”
Minimum 5 years’ ICD-10, CPT, HCPCS coding experience, along with previous experience in a medical record review role. Managed care experience is highly desired
Coding certification (CCS-P or CPC through AHIMA/AAPC) is required
Experience managing a team of employees in a consistent and professional manner
Experience creating and presenting educational content to staff and physicians
Excellent communication, customer service, and sound organization skills
Able to operate in a fast-paced environment and can handle change quickly and efficiently
Must be able to multi-task, and work both independently and as part of a tea
Independent of daily supervision, as well as follow instructions in the execution of tasks
Proficient in Microsoft Office (Excel, Word, and PowerPoint)
Expert Epic user
Bachelor’s degree or equivalent combination of education and experience
Internal Number: MEM003579
About MemorialCare Medical Foundation
Let us introduce ourselves. We're MemorialCare, a nonprofit health system that includes four hospitals, two medical groups, imaging centers, surgical centers and much more. As one of the leading health systems in Orange County and Los Angeles County, we're confident that no matter what your needs are, we have the teams, tools and know-how to support you every step of the way.