Manager - Coding / Reimbursement - Revenue Cycle

Department :

13265 Enterprise Revenue Cycle - PFS : Medical Necessity

Status : Full time

Benefits Eligible : Yes

Hou rs Per Week : 40

Schedule Details / Additional Information :

Varies

Job Summary

Monitors and oversees the day to day operations within the department. Accountable for the charge capture and claim resolution portion of the revenue cycle. The Manager must have thorough knowledge of ICD, CPT, and HCPCS coding principles.

Essential Functions

• Coaches and develops of supervisory team members.
• Works with leadership team to address provider needs and ensures communication is helpful, effective, and consistent.
• Ensures adherence to all departmental policies.
• Develops, implements, and monitors quality assurance reviews.
• Assesses, implements, and continuously monitors workflow and volumes to ensure workload is balanced among team members.
• Assesses and reacts to workflow changes related to departmental growth.
• Ensures effective communication with both internal and external customers.
• Develops, implements, and monitors a comprehensive training program to include career ladder development. Addresses departmental training needs based on team member performance and quality reviews.
• Conducts quality assurance reviews as needed. Provides education as a result of these reviews.
• Stays abreast and communicates coding changes (i.e. new codes, new technology, payor requirements).
• Monitors key performance indicators (KPIs) to include, but not limited to, denials, AR Trends, edit volumes, and charge lag.
• Participates in strategic planning and design in coding, regulatory, and system changes that impact coding, reimbursement, and compliance.
• Oversight of medical necessity work queues to address CCI, LCD, NCD, MUE, etc. edits prior to claims submission.
• Reviews denials for medical necessity to facilitate department review as needed, add modifiers, and make adjustments per payer policy

Physical Requirements

Works in a fast-paced office / hospital environment. Work consistently requires sitting and some walking, standing, stretching, and bending. Some travel may be required.

Education, Experience and Certifications

Bachelor's degree or 8 years related experience required. 1-3 years supervisory experience preferred. CPC or coding credential required. Demonstrates professional presence and effective presentation skills.

Pay Range

$37.50 - $56.25

Our Commitment to You :

Advocate Health offers a comprehensive suite of Total Rewards : benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including :

Compensation

Benefits and more

About Advocate Health

is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names in Illinois; in the Carolinas, Georgia and Alabama; and in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.