Director, Coding and Provider Education
Description
JOB SUMMARY
The Director of Coding and Provider Education is responsible for ensuring that healthcare providers, hospitals, and other medical facilities are following all coding regulations, policies, and procedures.
This includes managing the training and education of coders, physicians, other healthcare providers and billing staff on clinical documentation improvement and coding best practices; along with reviewing medical records and coding documentation for accuracy and ensuring that billing practices are in accordance with federal and state laws. They may also collaborate with other departments and stakeholders to identify areas for improvement and implement best practices for coding and billing.
Overall, the Director of Coding and Provider Education plays a critical role in ensuring that medical billing and coding practices are accurate, efficient, and in compliance with regulatory requirements, ultimately contributing to improved patient care and financial sustainability of the organization.
JOB REQUIREMENTS
Education
- High School diploma or equivalent required.
- Bachelor’s Degree in related field and/or In lieu of degree, six (6) years of relevant work experience will be accepted in addition to the experience requirement required.
Work Experience
- 5+ years of experience with Revenue Cycle Management required.
- 10+ years of leadership/training experience required.
Required Licenses/Certifications
- Certified coding certificate from AAPC or AHIMA required
Additional Knowledge, Skills and Abilities Required
- Experience with multiple practice management systems preferred.
- Expert level knowledge of Microsoft Office (Word and Excel) required
- Abel to analyze data, identify trends, make recommendations, and provide sound business reason to implement changes
Additional Knowledge, Skills, and Abilities Preferred
- Excellent written and verbal communication skills required.
- An innate desire for continuous operational improvement
Core Competencies:
- Collaboration: Takes ownership for collectively establishing productive partnerships and relationships and seek to gain joint understanding of priorities and objectives so that the greater good of the organization and those we serve is always at the forefront.
- Innovation: Consistently uses good judgment, applying creativity to overcome obstacles and increasing effectiveness and efficiency though process and other forms of innovation.
- Diversity and Inclusion: Fosters diversity and inclusion, to be able to better understand team members, our customers and partners. Engages the strengths and talents of each GoHealth team member, creating an environment of involvement, respect and connection where the richness of ideas, backgrounds and perspectives are harnessed.
- Integrity: Models and practices the highest ethical and professional standards; demonstrates pride and personal interest in our patients, partners and fellow team members, deeply engaging in the business. Makes decisions, with a focus on doing the right thing; treats team members, our customers, partners and vendors with dignity, consideration, open-mindedness and respect.
- Accountability: Always shows initiative, demonstrates a bias to action and gets things done. Actively accepts responsibility for diverse roles, obligations and actions that positively influence patient and customer outcomes, our partnerships and the healthcare needs of our communities
ESSENTIAL FUNCTIONS
- Progressive experience working with medical staff leadership and senior management Responsibilities
- Conducts regular audits of coding and billing practices to ensure that they comply with regulations, identify areas for improvement, and provide training and support to staff members as necessary.
- Analyzes coding data to identify trends and patterns in coding practices, billing patterns, and potential compliance issues. They also use data to develop strategies to improve coding and billing practices and reduce errors.
- Stays up to date with changes in coding regulations, policies, and procedures to ensure that the organization is always in compliance.
- Designs, develops, and implements coding education programs for clients and staff members in the organization.
- Provide education and training to coding staff, physicians, and other healthcare providers on CDI and coding best practices, including documentation requirements, coding guidelines, and compliance with regulatory requirements.
- Act as a liaison between coding staff and providers to facilitate communication and resolve coding-related issues.
- Establishes key metrics and performance indicators, analyzes operating results, taking adequate steps to correct shortfalls in performance.
- Assures establishment of recruiting, training and development programs, performance management and reward systems to attain the highest level of productivity for long-range success; systems to include provisions to meet all government laws and regulations.
- Responsible for managing elevated client expectations and proactively understanding client issues that may have an impact on success.
- Responds to escalated issues and works to resolve issues appropriately
- Collaborates cross functionally within the organization to ensure consistent client service levels are met.
- Leads the development and documentation of processes and workflows as assigned.
- Responsible for obtaining monthly performance metrics; adhering to all policies and procedures, within the most stringent attention to complying with all governmental and HIPAA mandated patient.
- Account for internal control responsibilities in line with the organization’s objectives.
- Ability to handle Protected Health Information in a manner consistent with the Health Insurance Portability and Accountability Act (HIPAA).
Other duties as assigned.