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Manager of Coding Documentation and Provider Billing

Company Commonwealth Care Alliance
Location Boston, MA 02108
Update 6 Day ago
The Manager of Provider Coding Documentation and Billing is responsible for all provider billing for CCA employed and capitated providers, including in particular overseeing coding review/quality assurance activities for generation of no-pay claims for CCA core clinical services as well as claims submission and resolution with other health plans for CCA’s primary care practice. The Manager oversees all coding and documentation improvement efforts. The Manager oversees the day-to-day operations of CCA’s Provider Billing Department and participates in strategic encounter and revenue generation activities. The Manager conducts, recommends, and educates CCA employed and capitated providers on all coding of services rendered.
S/he must effectively interact with multiple disciplines including management, advanced practice clinicians, nursing staff, physicians, commercial insurance carriers and government agencies. S/he must demonstrate self-direction, professionalism, effective communication skills, the ability to work in a team environment, a high-level expertise in understanding commercial and governmental insurance carrier rules and regulations, and the ability to manage ongoing change and think creatively.
  • Certification through a Professional Coding Program, such as AAPC, AHIMA, CPC, CCS-P, , RHIA required (CRC – Certified Risk Coder Preferred or obtained within 6 months)
  • 7+ years of experience in hospital and/or physician billing, coding or finance/billing area in a healthcare setting is required with direct experience in understanding and implementing billing compliance rules and regulations; with collaboration/interaction with the physician/provider community
  • Computer Skills a must
  • Visio, PowerPoint, Project Management Software (e.g., Microsoft Project)
  • In-state travel required
  • 5+ years of demonstrated managerial experience required
  • Managerial experience and the ability to assist staff with time management and set priorities
  • Assists with denials and appeals from insurance payers due to coding issues
  • Assists with charge entry, patient demographics, registration, collections and other insurance/billing functions
  • Oversees patient account collection processes and assists collector in processes
  • Conducts new employee orientation and periodic training updates
  • Maintains facilities, space and equipment to ensure a comfortable and safe working environment
  • Participates with Administration, Physicians and Managers/Supervisors in identifying new processes, procedures and services
  • Attends and participates in management meetings, physician meetings upon request, and continuing education
  • Demonstrates and promotes a positive patient/customer service attitude
  • Performs selection, orientation, discipline, evaluation, and dismissal of billing department personnel
  • Prepares staff schedules and ensures adequate staffing to meet demands of the department ; p repares, implements and manages existing and new departmental processes and procedures
  • Provides guidance and direction to provider billing personnel and to all CCA employed and capitated providers on submission of no-pay claims
  • Keeps department staff appraised of billing/revenue cycle/encounter strategies
  • Performs coding of services, procedures and diagnoses of services rendered by providers and departments
  • Reviews chart documentation for correct coding and missed revenue opportunities
  • Communicates and educates providers, administration, managers and staff on coding and documentation guidelines, rules and regulations
  • Strong working knowledge of billing, coding and documentation requirements for the hospital and physician inpatient and outpatient areas.
  • Excellent analytical, organizational, written, verbal and presentation skills are required with the ability to communicate with individuals at all levels of the organization and externally
  • Ability to solve problems independently and in a timely manner.
  • Thorough knowledge of government regulations relating to medical records documentation and reimbursement including Medicare and Medicaid and other industry billing standards
  • Strong understanding of medical terminology, ICD, CPT, and HCPCS coding and medical billing processes
  • Ability to work collaboratively with practice administration, clinical providers, and staff to implement best practices to ensure compliant and accurate billing
  • Advanced and current knowledge of CPT/HCPCS and ICD-10 coding
  • Subject matter expert in HCC coding, familiar with the Centers for Medicare and Medicaid Services (CMS) guidance related to Risk Adjustment Data Validation
  • Advanced and current knowledge of end-to-end billing methods and tools
  • Current working knowledge of Fair Collection laws
  • Working knowledge of methods, procedures, regulations and guidelines in patient billing
  • Current knowledge of insurance payer coding and reimbursement guidelines
  • Working knowledge and experience in health information system management, including billing and medical record applications
  • Ability to identify, initiate, implement and manage business practices, policies and processes
  • Proficient organizational skills, attention to detail and accuracy
  • Demonstrated ability to establish and maintain effective working relationships with internal and external parties
  • Ability to exercise initiative, problem-solving and decision making
  • Excellent interpersonal and communication skills
  • Demonstrated customer service oriented attitude/behavior

Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws