Manager Hospital Coding Assurance - 10K Sign On Bonus Available!

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

Work Shift

Day (United States of America)

Job Summary:

Under the direction of the Director of Coding Assurance - Compliance, the Manager of Hospital Coding Assurance is responsible for executing the Wellstar Health System Compliance Plan within the Coding Assurance Compliance Team. This person will lead WellStar's Inpatient and Outpatient Coding auditors in proactively identifying risk and addressing compliance issues as they pertain to coding/billing within the Wellstar Inpatient / Outpatient hospital populations. This department conducts regular audits and monitors activities to promote compliance with federal regulations related to the Federal Healthcare Programs (i.e. Medicare and Medicaid and others). This team provides compliance education with an emphasis on coding and billing regulations for Hospital services in Wellstar facilities. This person will coordinate the above audits/education, research and respond to compliance and other coding / billing related questions and prepare communication/responses both in verbal and in written formats. This person will be responsible for coordinating internal reviews, compliance training as well as targeted educational programs throughout each year. This team will look for trends in coding and billing patterns and provide comparative benchmarking to ensure optimal reimbursement while remaining in compliance with published guidelines and regulations. This person must be able to work independently, motivate a strong team, and must have professional communication skills both verbally and in writing.

Core Responsibilities and Essential Functions:

Manage Hospital Coding Assurance Audit Process - Implement and maintain audit controls and measurements for internal processes. - Develop management reports showing the results of the audit process. Works with the Director of Hospital Coding Assurance, Coding leadership, and other departmental leads as appropriate in developing action plans and follow-up initiatives to address the opportunities identified through the annual audit process. - Develop training and educational material associated with identified risk or audit findings. - Assist Director in providing oversight and leadership surrounding external audits. - Ensure correct processes are in place for accurate, complete and compliant coding/billing across hospital billing to include but not limited to the following: - Billing for items or services not rendered or not provided as claimed - Submitting claims that are not reasonable and necessary - Billing for non-covered services as if covered - Identification of risk areas involving Inpatient Admission criteria - Unbundling - Failure to properly use modifiers - Submitting claims with diagnoses / procedures not documented in the medical recordUpcoding / overcoding / undercoding - Failure to apply correct coding practices for Inpatient populations Manages communication from the Hospital Coding Assurance Team to Compliance and Coding leadership: - Chart documentation deficiencies and opportunities for improvement that may result in over coding and/or under coding - Trends in RAC or other governmental audit findings - Federal and state regulations governing billing (medical necessity, Inpatient Admission Criteria, etc) - National/Local Coverage Determination and Official Coding Guideline reviews appropriate for the procedure /test in question - Trends in denials - Results of benchmark comparisons such as PEPPER reports. - Claim issues involving hospital services (may need to incorporate other departments such as: PFS, Revenue Management, and other hospital departments as needed) Assists the Coding Assurance Director in developing, coordinating, and management of Annual Audit plan - Reviews OIG annual workplan - Identifies areas of focus related to WellStar services - Works with management teams in focus areas to complete risk assessment - Consolidates findings and creates recommendations for presentation to executive leadership team - Conducting investigations surrounding reports of coding/billing violations or other compliance related issues . - Assist with the development of corrective action plans. - Ensure the appropriate disclosures are completed and submitted. Communication of new/revised regulations/requirements - Provide support and guidance regarding implementation of new regulations as related to s