Facility Coding Quality Integrity Supervisor

Department:

10393 Revenue Cycle - Coding & HIM Support Facility/HIM

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

• Directs teams conducting formal audits of facility coding practices, coding documentation, and coding accuracy to identify areas for improvement and ensure compliance with coding regulations and directs team conducting prospective reviews prior to billing to ensure accuracy and to avoid denials.
• Collaborate with other Mid-Revenue Cycle Integrity leaders and relevant key stakeholders such as Compliance, Internal Audit, and Billing, Quality, and CDI to address coding-related issues and promote cross-departmental cooperation as appropriate.
• In collaboration with leader, communicate coding quality and audit findings, recommendations, and initiatives to senior Integrity leadership.
• Provide daily direction and guidance to the coding quality and audit team to meet assigned goals and to support continuous improvement efforts.
• Monitor key performance indicators (KPIs) and metrics related to facility coding quality, audit outcomes, productivity, and compliance.
• Prepare information for regular reports summarizing facility coding quality and audit findings, trends, and progress toward goals for senior Integrity leadership and regulatory reporting purposes.

Major Responsibilities:

• Supervises the timely, accurate review and validation of charges/codes assigned for billing. This includes charge review; claim edit and insurance rejections. At times, it may also include customer concerns that question coding. Ensures that coding practices and quality are consistent with coding and other regulatory requirements.
• Supervises highly functioning, self-directed work teams.
• Maintains up-to-date knowledge of Medicare, Medicaid and other regulatory requirements pertaining to nationally accepted coding policies and standards. Develops expertise in coding for assigned responsibilities.
• Oversees the Epic coding functions for all types of charges/codes coding production is responsible for to ensure that claims are submitted to payers in compliance with coding regulations and organizational guidelines.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines. Practices ethical judgment in assigning and sequencing codes for proper insurance reimbursement.
• Reports inconsistent processes systemwide. Documents all coding procedures and guidelines in writing and ensures all coding team members adhere to them. Identifies opportunities for process and quality improvement.
• Works directly with the Coding leadership to research and resolve issues.
• Ensures that documentation, coding procedures and requirements are clearly communicated and enforced to coding staff.
• Communicates and reinforces changes in CPT, ICD, HCPCS and other requirements and coordinates necessary modifications and updates to appropriate coding staff.
• Develop and updates department guidelines and procedures. Educate team members on coding related guidelines, procedures and practices.
• Identifies trends and report recommended resolution to charge capture, coding and billing issues and rejections.
• Performs human resources responsibilities for staff which includes coaching on performance, completes performance reviews and overall staff morale. Recommends hiring, compensation changes, promotions, corrective action decisions, and terminations.
• Responsible for understanding and adhering to the organizations Code of Ethical Conduct and for ensuring that personal actions, and the actions of employees supervised, comply with the policies, regulations and laws applicable to Advocate Aurora's business.

Licensure, Registration, and/or Certification Required:

• Coding Certification issued by one of the following certifying bodies: American Academy of  Coders (AAPC), or American Health Information Management Association (AHIMA)

Education Required:

• Bachelors degree (or equivalent knowledge) in Health Information Management or related field.

Experience