Physicians Coding and Compliance Manager, Hybrid
Company DescriptionThe University of Maryland Medical System is a 14-hospital system with academic, community and specialty medical services reaching every part of Maryland and beyond.
UMMS is a national and regional referral center for trauma, cancer care, Neurocare, cardiac care, women's and children's health and physical rehabilitation.
UMMS is the fourth largest private employer in the Baltimore metropolitan area and one of the top 20 employers in the state of Maryland.
No organization will give you the clinical variety, the support, or the opportunities for professional growth that you'll enjoy as a member of our team.
Job DescriptionThe successful candidate will have experience managing coders/biller on the Physician side of coding and compliance.
1.
Bachelor's Degree in business, finance or healthcare related field is required.
2.
American Academy of Professional Coders (AAPC) certification as a Certified Professional Coder (CPC) or Certified Coding Specialist - Physician (CS-P) is required.
3.
Seven years medical coding experience including five years of auditing experience.
Experience to include three years in a supervisory/management capacity, in a compliance environment is required.
General SummaryUnder supervision from the Director of Revenue Cycle Billing and Coding Compliance, the Manager will implement and manage the Compliance Auditing and Monitoring Program for professional services, consisting of scheduled prospective and retrospective claims and medical record audits to ensure services are reported accurately in accordance with applicable coding rules and regulations.
Responsible for direct oversight of Corporate Compliance and Business Ethics Group (CCBEG) Compliance Auditor, Professional Fee staff activities, including conducting professional audits and training.
Principal Responsibilities and TasksThe following statements are intended to describe the general nature and level of work being performed by people assigned to this classification.
They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
1.
Assists in creation of annual audit work plan for University of Maryland Medical System (UMMS) providers to ensure compliant documentation and coding of services are present as required for accurate claims submission.
Audits will be conducted in MDaudit, the automated audit management system utilized by UMMS.
2.
Creates the audit schedule and quarterly audit assignment for each Compliance Auditor, Professional Fee align with each auditor's area of specialty to ensure subject matter expertise expectations are met to address each provider's audit and training needs.
3.
Determine staffing requirements, productivity/quality standards while providing supervision of all direct reports to ensure effective and efficient departmental functions.
A.
Orient, train, conduct performance evaluations, establish corrective actions, and provide an open and goal-oriented work environment with established clear and concise work procedures and productivity standards.
B.
Develops staff by providing training opportunities to enhance individual employee's career development.
4.
Creates training materials and schedules for providers/practices related to annual coding updates and/or periodic changes to third-party federal regulatory and/or coverage policies.
5.
Develops and/or updates departmental professional audit policies and procedures, including but not limited to, audit program policies, scope of work, audit reporting, education and training, etc.
6.
Performs Quality Audits (QA) for all CCBEG Compliance Audit, Professional Fee to verify accuracy of coding, modifiers, and medical necessity.
Provides feedback on QA reviews and establishes management action plans for auditors failing to maintain acceptable passing score.
7.
Performs other duties as assigned.
QualificationsEducation and Experience1.
Bachelor's Degree in business, finance or healthcare related field is required.
2.
American Academy of Professional Coders (AAPC) certification as a Certified Professional Coder (CPC) or Certified Coding Specialist - Physician (CS-P) is required.
3.
Seven years medical coding experience including five years of auditing experience.
Experience to include three years in a supervisory/management capacity, in a compliance environment is required.
4.
Certified in Healthcare Compliance or other professional compliance certification (or achieve certification no later than 12 months from hire date).
Knowledge, Skills and Abilities1.
Maintains current knowledge and proficiency of the Centers for Medicare and Medicaid Services (CMS) rules and regulations related to documentation, coding, conditions of coverage for professional services.
2.
Maintains current knowledge and proficiency of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and International Classification of Diseases (ICD-10) coding and modifiers for the appropriate reporting of patient services and disseminates knowledge to CCBEG staff, UMMS providers, and practice areas as needed.
3.
Working knowledge of the regulatory issues associated with protected health information and CMS regulatory coding and billing requirements.
4.
Proficient knowledge of supervising, monitoring daily work activities, evaluating, training and motivating performance of staff.
5.
Demonstrates knowledge of MS Office software applications such as Microsoft Excel and Microsoft Word is required.
6.
Effective verbal and written communication and listening skills are required to interact with the Department's business partners, healthcare providers, and executive leadership.
7.
Ability to maintain a culture of excellent customer service, open and friendly staff relations and approachable demeanor with all levels of staffAdditional InformationVideos To Watchhttps:
//www.
youtube.
com/watch?v=1P7RWLM7UAE Recommended Skills Active Listening Billing Certified Coding Specialist Certified In Healthcare Compliance Certified Professional Coder Claim Processing Estimated Salary: $20 to $28 per hour based on qualifications.
UMMS is a national and regional referral center for trauma, cancer care, Neurocare, cardiac care, women's and children's health and physical rehabilitation.
UMMS is the fourth largest private employer in the Baltimore metropolitan area and one of the top 20 employers in the state of Maryland.
No organization will give you the clinical variety, the support, or the opportunities for professional growth that you'll enjoy as a member of our team.
Job DescriptionThe successful candidate will have experience managing coders/biller on the Physician side of coding and compliance.
1.
Bachelor's Degree in business, finance or healthcare related field is required.
2.
American Academy of Professional Coders (AAPC) certification as a Certified Professional Coder (CPC) or Certified Coding Specialist - Physician (CS-P) is required.
3.
Seven years medical coding experience including five years of auditing experience.
Experience to include three years in a supervisory/management capacity, in a compliance environment is required.
General SummaryUnder supervision from the Director of Revenue Cycle Billing and Coding Compliance, the Manager will implement and manage the Compliance Auditing and Monitoring Program for professional services, consisting of scheduled prospective and retrospective claims and medical record audits to ensure services are reported accurately in accordance with applicable coding rules and regulations.
Responsible for direct oversight of Corporate Compliance and Business Ethics Group (CCBEG) Compliance Auditor, Professional Fee staff activities, including conducting professional audits and training.
Principal Responsibilities and TasksThe following statements are intended to describe the general nature and level of work being performed by people assigned to this classification.
They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
1.
Assists in creation of annual audit work plan for University of Maryland Medical System (UMMS) providers to ensure compliant documentation and coding of services are present as required for accurate claims submission.
Audits will be conducted in MDaudit, the automated audit management system utilized by UMMS.
2.
Creates the audit schedule and quarterly audit assignment for each Compliance Auditor, Professional Fee align with each auditor's area of specialty to ensure subject matter expertise expectations are met to address each provider's audit and training needs.
3.
Determine staffing requirements, productivity/quality standards while providing supervision of all direct reports to ensure effective and efficient departmental functions.
A.
Orient, train, conduct performance evaluations, establish corrective actions, and provide an open and goal-oriented work environment with established clear and concise work procedures and productivity standards.
B.
Develops staff by providing training opportunities to enhance individual employee's career development.
4.
Creates training materials and schedules for providers/practices related to annual coding updates and/or periodic changes to third-party federal regulatory and/or coverage policies.
5.
Develops and/or updates departmental professional audit policies and procedures, including but not limited to, audit program policies, scope of work, audit reporting, education and training, etc.
6.
Performs Quality Audits (QA) for all CCBEG Compliance Audit, Professional Fee to verify accuracy of coding, modifiers, and medical necessity.
Provides feedback on QA reviews and establishes management action plans for auditors failing to maintain acceptable passing score.
7.
Performs other duties as assigned.
QualificationsEducation and Experience1.
Bachelor's Degree in business, finance or healthcare related field is required.
2.
American Academy of Professional Coders (AAPC) certification as a Certified Professional Coder (CPC) or Certified Coding Specialist - Physician (CS-P) is required.
3.
Seven years medical coding experience including five years of auditing experience.
Experience to include three years in a supervisory/management capacity, in a compliance environment is required.
4.
Certified in Healthcare Compliance or other professional compliance certification (or achieve certification no later than 12 months from hire date).
Knowledge, Skills and Abilities1.
Maintains current knowledge and proficiency of the Centers for Medicare and Medicaid Services (CMS) rules and regulations related to documentation, coding, conditions of coverage for professional services.
2.
Maintains current knowledge and proficiency of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and International Classification of Diseases (ICD-10) coding and modifiers for the appropriate reporting of patient services and disseminates knowledge to CCBEG staff, UMMS providers, and practice areas as needed.
3.
Working knowledge of the regulatory issues associated with protected health information and CMS regulatory coding and billing requirements.
4.
Proficient knowledge of supervising, monitoring daily work activities, evaluating, training and motivating performance of staff.
5.
Demonstrates knowledge of MS Office software applications such as Microsoft Excel and Microsoft Word is required.
6.
Effective verbal and written communication and listening skills are required to interact with the Department's business partners, healthcare providers, and executive leadership.
7.
Ability to maintain a culture of excellent customer service, open and friendly staff relations and approachable demeanor with all levels of staffAdditional InformationVideos To Watchhttps:
//www.
youtube.
com/watch?v=1P7RWLM7UAE Recommended Skills Active Listening Billing Certified Coding Specialist Certified In Healthcare Compliance Certified Professional Coder Claim Processing Estimated Salary: $20 to $28 per hour based on qualifications.
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