Compliance Coding Auditor/Educator Supervisor

POSITION DESCRIPTION:
Oversees the Professional Coding Auditors and Education team, ensuring proper assignment of diagnosis and procedure codes, monitoring accuracy of Centralized Coding team charge capture and coding with proper ICD-10, CPTs, HCPCs, and proper modifiers. This includes ongoing reviews of patient medical record documentation and procedural and diagnosis coding for practitioner education in areas related to coding, documentation and compliance. Provides guidance to ensure rendered services are coded and charged within expected timeframes. Ensures adherence to policies and procedures; effectively and timely addresses barriers as they arise. Emphasis is placed on adherence to Corporate Compliance Program, compliance with insurance carrier standards, optimizing revenues and avoidance of monetary settlements from third party audits.
ESSENTIAL JOB FUNCTIONS:

1. Supervises the work of assigned staff including monitoring staff competencies. Develops goals and objectives, conducts annual performance appraisals and the utilization of performance resolution process when needed.
2. Holds crucial conversations and leads team members based on their individual development levels.
3. Assists the Regional Manager-Professional Auditor and Educator with the recruitment, hiring, orientation, training and coaching of new team members in accordance with local and Trinity guidelines. Updates and organizes training materials for new colleagues.
4. Coordinates team schedules to ensure adequate coverage to fulfill policy and procedure requirements.
5. Maintains Time & Attendance program; coordinates timekeeping and time-off requests.
6. Assists with complex medical record documentation audits or issues.
7. Compiles, analyzes and presents data related to performance, compliant billing and documentation issues.
8. Communicates medical coding process improvements as appropriate to the Centralized Coding team and Revenue Cycle Site Operations leadership.
9. Identifies auditing priorities and enhances workflow to minimize Epic Pre-AR, AR and Denial days.
10. Identifies and reports compliance risks in coding and documentation practices to Manager. Collaborates with Trinity Compliance team to develop recommendations and effectively communicate solutions.
11. Encourages communication and cooperation between departmental teams to enhance overall performance.
12. Identifies medical record documentation patterns/trends impacting coding and reimbursement; and coordinates educational materials and communications.
13. Attends required internal and external meetings, performs other administrative support tasks, and assists in the development and oversight of the department budget.
14. Assists with special projects as assigned.
15. Performs other related duties as assigned.

ORGANIZATIONAL EXPECTATIONS:

1. Creates a positive, professional, service-oriented work environment by supporting the mission and values of both IHA and Trinity Health.
2. Must be able to work effectively as a member of the RSO team.
3. Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.
4. Successfully completes IHA's "The Customer" training and adheres to IHA's standard of promptly providing a high level of service and respect to internal or external customers.
5. Maintains knowledge of and complies with IHA standards, policies and procedures.
6. Maintains general knowledge of IHA office services and in the use of all relevant office equipment, computer and manual systems.
7. Maintains strict patient and employee confidentiality in compliance with IHA and HIPAA guidelines.
8. Serves as a role model by demonstrating exceptional ability and willingness to take on new and additional responsibilities. Embraces new ideas and respects cultural differences.
9. Uses resources efficiently.
10. If applicable, responsible for ongoing professional development - maintains appropriate licensure/certification and continuing education credentials, participates in available learning opportunities.

MEASURED BY:
Performance that meets or exceeds IHA CARES Values expectation as outlined in IHA Performance Review document, relative to position.
ESSENTIAL QUALIFICATIONS:
EDUCATION: Bachelor's Degree or equivalent combination of education and experience.
CREDENTIALS/LICENSURE: Certified Professional Coder (CDC), Certified Risk Adjustment Coder (CRC) or Certified Documentation Expert Outpatient (CDEO) or able to obtain within 6 months. Maintains annual CEU requirement.
MINIMUM EXPERIENCE: 3 years of Professional coding experience. 5 years' recent professional coding experience preferred. Previous supervisor or leadership experience, includes team leader or educator role, preferred.
POSITION REQUIREMENTS (ABILITIES & SKILLS):

1. Ability to apply complex coding rules, numerous payer rules and standards.
2. Broad-based knowledge of healthcare insurance, patient billing and collection practices, and at-risk and capitated payments.
3. Maintains substantial working knowledge of federal, state, and insurance company regulations and contract requirements affecting compliance in a healthcare setting; including compliance plan and auditing standards.
4. Strong knowledge of ICD-10-CM and CPT-4 coding, reimbursement systems, medical terminology, anatomy and physiology/pharmacology, data collection techniques, and federal, state, and payor-specific regulations pertaining to documentation and coding.
5. Subject matter expert knowledge of managed care and insurance practices, insurance claims and billing process, fee schedules and pricing. Ability to research billing guidelines effectively to provide direction on Compliance Coding.
6. Ability to work independently and to effectively supervise functional area within the team, supervise processes, support more complex issues, and provide feedback and guidance to staff. Ability to have crucial conversations and lead team members based on their individual development levels.
7. Ability to inspire and motivate others to perform well; accepts feedback from others; gives appropriate recognition to others.
8. Strong analytical, change management and lean methodologies skills.
9. Ability to independently review and apply high critical thinking skills, consider medical necessity of the presenting problem and analyze levels of medical decision-making.
10. Ability to apply logic to assumptions and decision-making for areas that are not a black or white assumption.
11. Ability to develop workable implementation plans; communicate changes effectively; build commitment and overcome resistance. Ability to prepare and support those affected by change and monitor transition and evaluate results.
12. Proficiency in multi-tasking and meeting sensitive deadlines in a fast-paced environment with a personal commitment to producing the highest quality work and providing extraordinary customer service; demonstrated ability to effectively follow through on assigned projects.
13. Possesses excellent customer service and problem-solving abilities, collaborative and positive coaching skills.
14. Proficient in operating a standard desktop and Windows-based computer system, including but not limited to, Microsoft Word and Excel, PowerPoint, intranet and computer navigation. Ability to use other software as required while performing the essential functions of the job including EPM and EHR systems.
15. Demonstrated understanding and/or hands-on experience with office processes, procedures and workflows.
16. Excellent professional and interpersonal communication skills in both written and verbal forms, such as via query, including proper phone etiquette.
17. Ability to speak before groups of people, either in-person or virtually.
18. Ability to work collaboratively in a team-oriented environment; displays courteous, professional and friendly demeanor.
19. Ability to work effectively with various levels of organizational members and diverse populations including West MI Revenue Cycle Site Operations staff, IHA staff, senior management, committees, providers, patients, family members, insurance carriers, vendors, external/internal customers and community groups.
20. Cultivates productive working relationships and maintains effective levels of communication between key stakeholders for all aspects of services provided.
21. Ability to approach conflict in a constructive manner. Helps to identify problems, offer solutions and participate in their resolution.
22. Good organizational and time management skills to effectively juggle multiple priorities and time constraints in a fast-paced environment.
23. Ability to exercise sound judgment and problem-solving skills.
24. Ability to maintain any organizational information in a confidential manner.
25. Successful completion of IHA competency-based program within introductory and training period.
26. Ability to drive to offices and other training sites to educate staff and/or providers.
27. Ability to work overtime hours as scheduled.