Assistant Director - Coding & Claims

UHS•Tredyffrin Township, PA

21h

About The Position

Independence Physician Management (IPM), a subsidiary of UHS, was formed in 2012 as the physician services unit of UHS. IPM develops and manages multi-specialty physician networks and urgent care clinics which align with UHS acute care facilities. It also provides select services for the Behavioral Health division of UHS. Through continuing growth, IPM operates in 11 markets across six states and the District of Columbia. Our leadership team, practitioners, and teams of healthcare professionals are collectively dedicated to improving the health and wellness of people in the communities we serve. To learn more about IPM visit Physician Services - Independence Physician Management - UHS. The Assistant Director - Coding & Claims is responsible for overseeing coding, coding audits, coding education, and claims and billing. This position drives consistency across all lines of business, ensuring that coding is handled consistently and collaboratively, ensures that coding audits are aligned with the policies set forth by the organization, and the provider coding education is provided routinely to ensure accurate and complete medical record documentation and the correct use of CPT-4 and ICD-10 codes to ensure adherence to established Government and third party billing guidelines, AMA, AAP, CMS and coding policies.

Requirements

Associates degree with 8-10 years' experience working in a healthcare (professional) billing, health insurance, and coding or equivalent operations work environment. Five of those years must be with direct supervisory experience. AAPC CPC Certification required.
Healthcare (professional) billing, knowledge of CPT/ICD-10 coding, government, government sponsored and commercial follow-up requirements as well as appeals processes and requirements. Thorough understanding of the revenue cycle and how the various components work together
Excellent verbal/written communication skills. Strong presentation skills. Proven track record of leadership ability. Results oriented with a proven track record of accomplishing tasks and building high-performing teams. Project Management. Strong interpersonal and organization skills. Service-oriented/customer-centric. Microsoft Office. Strong computer literacy skills
Mainframe billing software (e.g., Cerner, Epic, IDX) experience highly desirable. Microsoft skills required (i.e., Excel, Power Point)

Responsibilities

Directs and guides all coding, charge capture, and charge reconciliation workflows for all lines of business to ensure that optimal workflows are achieved. Sets forth quality and productivity standards and monitors results to align teams with industry standards
Enhances workflows to achieve a two-day charge lag and tightens processes to mitigate opportunities for missed charges
Directs coding audits with both internal and external auditors to align audits with the organization’s policies and procedures. Trends deficiencies found in audits and guides the Coding Educator on trends identified that need to be addressed globally. Monitors the pass/fail rate of audits and works to enhance education to increase the pass rate. Monitors the completion time for encounters held for prebill audits and shifts resources as necessary to ensure that hold times do not exceed five business days
Oversees coding education and directs the strategy and work plan for the education program to ensure that applicable education is provided to the right employees at the right time using the right delivery model. Measures the success of the education program by increased pass rates in audits, shorter pre-bill audits lengths, and greater compliance with new coding initiatives. Guides necessary changes in strategy when success measures are not trending positively
Directs the Claims and Billing work to maintain effective workflows and viable claim edits that promote an increased clean claim rate, decrease DNFB, fast resolution of claims with rejections/edits/holds. Guides the implementation of workflows that create an efficient path for claims being accepted into the payer’s adjudication systems in a timely manner. Sets forth quality and productivity standards and monitors results to align teams with industry standards
Demonstrates excellent initiative and judgement. Works independently applying effective approaches to task prioritization, time management, delegation of tasks and meeting deadlines. Exhibits outstanding decision making and customer service
Promotes a work environment of accountability and ownership. Sets appropriate standards of performance and communicates clear expectations to the Team. Shows direct and tangible evidence of coaching, mentoring and professional development
Conducts monthly one-on-one meetings with direct reports to provide a structured time to provide coaching, discuss accomplishments and review the status of revenue cycle operations within their scope of responsibility. Discuss areas of professional development as well as goal tracking/reporting, projects and other pertinent topics. Maintains comprehensive and concise documentation of the one-on-one meetings, next steps and expectations
Manages the employment hiring process. Prepares well thought-out and meaningful performance appraisals for direct reports summarizing performance as well as focusing on opportunities for improvement and recognizing performance that exceeds expectations