Senior Manager, Coding Auditing & Training

Bachelor's degree is required.
Certification is required.
7 - 10 years experience required.
The Senior Manager, Coding Auditing & Training manages the team responsible for leading CPT assignment training for newly onboarded physicians and mid-level providers across all Steward Medical Group markets. The activities performed by this team include: auditing new providers as described per SMG policy, educating/re-educating coding staff and providers as necessary, reviewing and validating various charges generated by providers, and participating in facility committees and ad hoc meetings as requested. The Senior Manager is the leader of the team and expected to perform in accordance with all policies and procedures, follow standards for ethical business conduct, and serve as a positive role model for the team. This position will report to directly to the Director of Revenue Integrity, who oversees all coding and compliance functions.
Job Duties:
Lead daily operations of the Training and Auditing function and staff, including monitoring the quality and quantity of workflow to ensure the completion of work assignments.
Provide oversight for coding, documentation, and billing audits, including summarizing audit findings and proposing recommendations. Oversee implementation of audit recommendations as appropriate. Perform follow-up audits and reviews to monitor and validate ongoing compliance with applicable rules and guidelines.
Educate practices/providers on basic coding, documentation, and billing issues related to appropriately entering charges and documenting the services delivered in compliance with applicable rules and regulations.
Coordinate and direct internal staff and external coding resources in order to meet specific objectives and timelines for coding activities.
Educate key stakeholders on significant matters related to coverage decisions, coding issues, and new or revised regulations.
Maintain excellent intradepartmental communication and build/maintain relationships with Practice Management and other departments and employees throughout Steward.
Based on experience and industry knowledge, make recommendations to streamline processes related to accurate and appropriate revenue capture for services performed, ensuring compliance with all appropriate regulations and guidelines.
Identify and implement improvement measures that will enhance department operations and customer service.
Complete required continuous training and education, including department specific requirements.
Maintain certifications and stay current on industry trends.
Design and implement work flow processes to support continuous improvement.
Provide cost effective management of resources for the Training and Auditing team.
Monitor and report all required performance measures to include the development of department goals and assist in the assessment of goal attainment.
Conduct and recommend trainings to improve team performance.
Resolve any employee personnel issues by following SMG's HR policies, including escalating issues as required.
Qualifications Required:
Bachelor's degree
10+ years coding experience, 5+ years of management experience
Advanced experience utilizing Microsoft Excel, including Pivot tables
Beginner/Intermediate experience with Microsoft Access preferred
Thorough knowledge of health care operations, physician practice reimbursement (including RVUs), charging practices, governmental coding requirements (including extensive knowledge of CPT/HCPCS/ICD and modifiers), and healthcare financial systems
Experience in researching, interpreting, and applying Medicare, Medicaid, MASSHEALTH, and other third-party payer regulations is essential.
Excellent problem-solving ability, as well as analytical, communication, leadership, initiative, and management skills are a necessity
Current certification as a CPC or CCS-P is required
Certification in Health Care Compliance (CHC) highly desired

Don't Be Fooled

The fraudster will send a check to the victim who has accepted a job. The check can be for multiple reasons such as signing bonus, supplies, etc. The victim will be instructed to deposit the check and use the money for any of these reasons and then instructed to send the remaining funds to the fraudster. The check will bounce and the victim is left responsible.

More Jobs

Senior Manager, Financial Audit and Accounting
Charlestown, MA University of Massachusetts Medical School
Senior / Manager Level Audit Associate
Boston, MA Kforce
Senior Manager, Systems Training
Cambridge, MA Sanofi Group
Senior Manager, Audit (Multiple Positions), Bo...
Boston, MA KPMG
Audit Senior Manager - Technical Accounting Co...
Boston, MA McGladrey LLP