Manager, Revenue Assurance - Revenue Integrity (Medical Coding)

Manager, Revenue Assurance - Revenue Integrity (Medical Coding)

Coordinates accurate assignment of system codes for billing and revenue processes by managing work to translate charge throughput guidelines and services capture code reviews. Reviews include codes, pricing, and data integrity impacting throughput for accuracy and completeness in alignment with coding and billing guidelines. Monitors account reviews and maintenance of system codes to ensure codes are updated, compliant, and accurately reflect policy and regulatory changes. Manages monitoring activities and process improvements by overseeing tasks related to analyzing findings from monitoring activities, identifying deficiencies and/or compliance issues, partnering with other departments to resolve deficiencies and/or compliance issues, and implementing corrective action plans. Supervises team members providing guidance to department, physicians, and practitioners by consulting on coding/billing issues, charging inquiries, and relevant policies and regulations.

Essential Responsibilities:

• Provides developmental opportunities for others; builds collaborative, cross-functional relationships. Solicits and acts on performance feedback; works closely with employees to set goals and provide open feedback and coaching to drive performance improvement. Pursues professional growth; develops and provides training and development to talent for growth opportunities; supports execution of performance management guidelines and expectations. Leads, adapts, implements, and stays up to date with organizational change, challenges, feedback, best practices, processes, and industry trends. Fosters open dialogue amongst team members, engages, motivates, and promotes collaboration within and across teams. Delegates tasks and decisions as appropriate; provides appropriate support, guidance, and scope; encourages development and consideration of options in decision making.
• Manages designated work unit or team by translating business plans into tactical action items; oversees the completion of work assignments and identifies opportunities for improvement; ensures all policies and procedures are followed. Aligns team efforts; builds accountability for and measuring progress in achieving results; determines and ensures processes and methodologies are implemented; resolves escalated issues as appropriate; sets standards and measures progress. Fosters the development of work plans to meet business priorities and deadlines; obtains and distributes resources. Removes obstacles that impact performance; identifies and addresses improvement opportunities; guides performance and develops contingency plans accordingly; influences teams to execute in alignment with operational objectives.
• Facilitates the accurate assignment of system codes for billing and revenue processes by: managing work performed by team members to translate charge throughput guidelines and services into codes to facilitate accurate billing of services provided; delegating tasks across the team to review codes configured in the system for proper alignment with charge throughput and coding guidelines and services; and reviewing recommendations for charge integrity updates based on teams analysis of regional and national policies and approving changes that will have considerable impact across the organization.
• Oversees routine review and maintenance of system codes by: monitoring the regular review (e.g., quarterly, annually) of coding records to ensure codes are updated, compliant, and accurately reflect policy and regulatory changes; providing guidance on conducting pre- and post- implementation assessments of automated and manual charge capture for quality and accuracy; reviewing analyses of complex and/or region-wide billing issues related to charges/codes and guiding the resolution of charge capture issues; and contributing to the maintenance of all Current Procedural Terminology (CPT)/ Healthcare Common Procedure Coding System (HCPCS) codes, descriptions, revenue codes, Relative Value Units (RVU) information, and generic codes to assist in the understanding of fee schedule implications.
• Serves as a billing and coding expert for the department by: supervising team members in providing guidance to other departments, physicians, and practitioners on coding/billing issues, charge inquiries, and relevant policies and regulations, offering guidance as needed; and providing guidance on the development and implementation of trainings to improve revenue cycle processes and outcomes, which may involve providing trainings to department staff and other departments.
• Manages monitoring activities and process improvements by: overseeing the performance of tasks that support monitoring activities of the region(s) documentation, charge capture, coding, billing, and/or compliance activities; providing guidance on analyzing findings from monitoring activities to identify deficiencies and/or compliance issues in billing codes and processes and partnering with other departments to resolve deficiencies and/or compliance issues; driving the development of reports of monitoring activity results to share with department leaders and/or other departments; and ensuring the implementation of corrective action plans resulting from monitoring activities.

Knowledge, Skills and Abilities: (Core)

• Ambiguity/Uncertainty Management
• Attention to Detail
• Business Knowledge
• Communication
• Constructive Feedback
• Critical Thinking
• Cross-Group Collaboration
• Decision Making
• Dependability
• Diversity, Equity, and Inclusion Support
• Drives Results
• Facilitation Skills
• Health Care Industry
• Influencing Others
• Integrity
• Leadership
• Learning Agility
• Organizational Savvy
• Problem Solving
• Short- and Long-term Learning & Recall
• Strategic Thinking
• Team Building
• Teamwork
• Topic-Specific Communication

Knowledge, Skills and Abilities: (Functional)

• Compliance Management
• Confidentiality
• Data Quality
• Health Care Coding
• Health Care Policy
• Maintain Files and Records
• Revenue Cycle
• Root Cause Analysis

Minimum Qualifications:

• Minimum three (3) years of experience in a leadership role with or without direct reports.
• Minimum three (3) years of experience in medical coding/billing (e.g., ICD-10, CPT, HCPCS).
• Bachelors degree in Business, Finance, Health Information Management, or related field AND minimum six (6) years of experience in revenue cycle, pricing, charge description/fee schedule development, claims billing, or directly related field OR Minimum nine (9) years of experience in revenue cycle, pricing, charge description/fee schedule development, claims billing, or a directly related field.

Preferred Qualifications:

• Certified Coding Specialist (CCS) OR Certified Coding Specialist - Physician-based (CCS-P) OR Certified Professional Coder (CPC) OR Certified Professional Coder - Hospital (CPC-H) OR Registered Health Information Administrator (RHIA) OR Registered Health Information Technician (RHIT).
• EPIC certification OR completion of an accredited EPIC Proficiency training program.

Primary Location: California, Pasadena, Walnut Center - Regional Offices Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 08:00 AM Working Hours End: 04:30 PM Job Schedule: Full-time Job Type: Standard Worker Location: Flexible Employee Status: Regular Employee Group/Union Affiliation: NUE-PO-01|NUE|Non Union Employee Job Level: Manager with Direct Reports Department: Po/Ho Corp - Revenue Integrity - 0308 Pay Range: $106900 - $138270 / year