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This position is responsible for promoting financial viability by effectively managing all aspects of the enterprise organizations coding department. This position works in close partnership with various members of the organizations leadership staff and is central in creating a comprehensive and seamless coding process throughout WVU Medicine.
As a member of the coding leadership team this position requires participation in operations, strategic planning, physician relations, finance, resource allocation and/or contracting as appropriate. This position provides enterprise departmental direction relative to all aspects/activities that ensure the attainment of the goals of the coding department, which ultimately assist WVU Medicine in achieving favorable hospital/clinics operating results.
MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Bachelor’s degree in Healthcare Management, Business, Finance or Accounting AND Five (5) years of in-depth experience within healthcare operations, patient account services, revenue cycle operations, healthcare auditing, or coding/billing either from a consulting perspective or as an employee/manager OR;
Associate’s Degree in Health Information Technology AND Seven (7) years of in-depth experience within healthcare operations, patient account services, revenue cycle operations, healthcare auditing, or coding/billing either from a consulting perspective or as an employee/manager OR;
In Lieu of Bachelor or Associate’s Degree, Nine (9) years of experience of in-depth experience within healthcare operations, patient account services, revenue cycle operations, healthcare auditing, or coding/billing either from a consulting perspective or as an employee/manager.
PREFERRED QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Master degree in Finance, Business Administration, Healthcare Administration or related field preferred.
2. Coding certification via AHIMA or AAPC or strongly preferred.
EXPERIENCE:
1. Seven (7) years of in-depth experience within healthcare operations, patient account services, revenue cycle operations, healthcare auditing, or coding/billing either from a consulting perspective or as an employee/manager.
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
1. Directs the staff and operations of the coding department. Ensures optimal performance through effective employee selection, training and development and performance management. This position is directly responsible for leading the coding supervisors and the coding teams at multiple locations and indirectly responsible for all employees within the department.
2. Holds staff accountable for achieving plans and performance targets. Works with staff to identify and resolve the most complex issues and problems impacting the department. Supports development and continued professional growth to meet company and individual goals for long-term success. Demonstrates an expectation for continuous quality improvement utilizing processes that include consideration of all stakeholders.
3. Develops a high-performing team that provides superior project management skills and supports the overall coding department to drive and improved financial performance in accordance with state and federal guidelines and standards.
4. Maintains strong understanding of coding metrics, leadership skills, project management, and leads the team in building plans to support operational departments to achieve optimal practice performance through strong analytical capabilities, process improvement identification, and technology enhancements. Ensures compliance with government and commercial coding regulations and standards while maximizing reimbursement for patient claims. Works with company compliance and legal staff to maintain appropriate procedures and to represent the company in litigated matters. Advises management of actions and potential risks.
5. Leads the coding departments strategic plan objectives and operational goal setting and execution through departmental leadership.
6. Design, implement, and ongoing monitoring of all relevant key performance indicators to ensure that cash flow is maximized throughout the revenue cycle.
7. Continuously evaluates the effectiveness and efficiency of operations and implements or proposes optimization or transformation efforts. Continually identifies opportunities for enhancement and optimization of the overall coding process of the organization. Reviews current best practices for coding department and other functions and makes improvements as needed.
8. Develops and maintains strong relationships with clients / providers. Effectively manages relationships and business processes at all clinics / physician offices and hospitals. Establishes and maintains strong working relationships with Revenue Cycle leaders and fosters a strong working relationship with Information Services.
9. Develops, implements and effectively manages policies, processes and procedures for the coding department that result in maintaining coding charge lag, productivity, and coding quality at or above goal levels. Provides education and policy updates for clinic, hospital and division employees, medical staff on policy or procedures. Establishes and conducts performance reporting for revenue / coding activities of each location. Works collaboratively with local CFO's, physicians, department heads, and practice manager(s) to develop and maintain a culture of high performance and accountability across organizational boundaries.
10. Provides regular revenue management reports to clients, providers, and management. Alerts senior management of concerns and provides status of financial conditions of the company by collecting, interpreting and reporting key financial data. Communicates coding changes and CPT updates.
11. Manages operational expenses in accordance with the budget. Directs and oversees the development of operating and capital budget for the department.
12. Works with IT to implement system-wide programs and information systems to create and maintain functional capabilities that equal the best in the industry. Provides ongoing leadership and operational oversight in the development, use and maintenance of the clinics and hospital information systems for coding. Provides coding oversight for system implementations, conversions, and upgrades for revenue cycle applications.
13. Address any operating issues that are hindering the maximization of cash flow, which may result in adopting new best practices.
14. Works collaboratively with coding department leadership to meet strategic goals and develop guidelines and procedures through use of data analysis.
15. Arranges for billing/coding audits as required and appropriate with contracted compliance company.
16. Continually ensures high ethical standards, and promotes and leads coding transparency, and a commitment to client service excellence.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Prolonged periods of sitting and standing.
2. Visual strain may be encountered in viewing of computer screens and written material.
3. Travel is required.
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Standard Office Environment.
SKILLS AND ABILITIES:
1. Has excellent analytic and problem-solving skills to process auditing and monitoring reports, identify compliance risks and prioritize recommendations. Determine methods and types of analyses to be performed to address a business question. Ability to interpret and question data inputs and support alternative recommendations as necessary.
2. Ability to investigate and resolves complex problems and coordinates efforts to provide innovative strategies and solutions.
3. Ability to identify key quarterly goals and execute against them.
4. Ability to communicate ideas and data both verbally and written, in a persuasive, organized and appropriate manner, including running meetings and preparing presentations for internal and external groups. Develop presentations to communicate progress on work across all areas.
5. Ability to take major strategic objectives and break them down into meaningful action steps.
Additional Job Description:
Scheduled Weekly Hours:
40
Shift:
Exempt/Non-Exempt:
United States of America (Exempt)
Company:
SYSTEM West Virginia University Health System
Cost Center:
539 SYSTEM HIM Provider Based Coding Analysis
