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JOB SUMMARY

The Coding Manager oversees coding operations for the RCM vendor, ensuring compliance with industry standards and optimizing revenue cycle processes.

JOB REQUIREMENTS

Education

• High School Diploma or GED required
• Bachelor’s degree in Business Administration or related field preferred

Work Experience

• Minimum of 7 years outpatient EM/office procedure coding
• Minimum of 3 years progressive management experience
• Knowledge of revenue cycle

Required Licenses/Certifications

• AHIMA or AAPC certification (CPC, CCS, CCS-P)

Additional Knowledge, Skills and Abilities Required

• CMS and AMA coding guidelines
• Knowledge of payor guidelines impacting compliant coding
• Knowledge of billing practices
• Knowledge of EMR required
• Strong communication skills.
• Excellent interpersonal skills
• Strong organizational skills

Additional Knowledge, Skills, and Abilities Preferred

• Epic or eClinicalWorks experience
• Experience with Microsoft Excel and Word

ESSENTIAL FUNCTIONS

• Maintain Daily communication with direct reports and team leads.
• Establish and maintain a high-level customer service approach to working with internal and external customers
• Interview, hire, and review team members
• Recommend team for structured quarterly bonus calculation
• Provide training for all staff
• Manages Physician professional fee coding to ensure compliance to GoHealth policies and procedures
• Oversees, directs, and guides coding specialist and team leads. Responsible and accountable for coding accuracy, timeliness, editing, and utilization of systems and tools used to perform coding functions.
• Identify coding, charge entry, or clinical documentation opportunities and works with the appropriate team member to make recommendations for improvement
• Proactively seeks out positive or negative trends in charge/coding capture processes to facilitate sharing of best practice and/or performance improvement
• Utilizing data and reports, performs root cause analyses to identify areas where the process may not be working effectively or efficiently.
• Analyzes KPI data
• Assures industry accepted coding principles, government regulations, protocols, and third-party requirements pertaining to billing and documentation are followed
• Provides accurate and appropriate answers to physicians’ coding and billing questions on a timely basis
• Aligns knowledge of coding and documentation requirements

Required knowledge, skills and ability:

Customer service skills:

• Ability to represent the Department in a professional manner when interacting with patients, guests, physicians and their staff
• Ability to handle service issues professionally
• Ability to follow through with customers

Communication Skills:

• Ability to communicate effectively to patients, centers, and staff regarding departmental policy
• Ability to communicate effectively to partners, providers, and vendors

Keyboard skills:

• Ability to type proficiently

Teamwork:

• Ability to function effectively as extension of the Center
• Be flexible and open-minded in thought processes
• Maintain focus under pressure
• Share relevant information with other team members

Medical Terminology & Insurance

• Ability to understand basic medical terminology
• Ability to calculate deductible and co-insurance correctly
• Ability to read and understand carrier Explanation of Benefits

Note: this job description is not inclusive of all the duties of the position. You may be asked by leaders to perform other duties. Management reserves the right to revise this position description at any time.

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All qualified persons are granted an equal opportunity for employment without regard to race, color, religion, sex, sexual orientation and gender identity or expression, age, national origin, citizenship status, disability, genetic information, medical condition, family care leave status, pregnancy or pregnancy-related condition, otherwise qualified disabled or veteran status. The company will comply with all fair employment laws in each of the jurisdictions where we conduct business.

For applicants in California, please review our California Consumer Privacy Statement here. https://www.gohealthuc.com/privacy-policy