[Hiring] Manager Professional Billing Coding Operations @BMC Software

Role Description

Responsible for the operational functions of the Professional Coding Operations team for BUMG. Plays a strategic role in validating the accuracy of CPT, HCPCS and diagnosis code assignment by coders, physicians and non-physician practitioners. Works closely with key revenue cycle stakeholders to understand reasons for denials, root cause analysis, and feedback to providers. Supervises professional billing coding staff. Partners with Coding Education Team to identify trends in coding practices and assists with developing feedback and education to providers. Reviews coding denials to resolve and identify trends and provides feedback to providers and departments. Performs quality assurance reviews of inpatient and outpatient records to assess and report on the effectiveness of training programs and quality of coders. Provides in-service training and feedback to coding staff regularly, including coding changes and updates. Oversees coding operations to ensure organizational goals are being met. Partners with the Coding Education Team to design and implement programs on coding and clinical documentation audit and education to improve performance and efficiency. Enforces correct application of Official Coding Rules and Regulations and follows appropriate guidelines. Oversees the coding edits and denials and ensures compliance with payer guidelines. The Manager, PB Coding Operations is responsible for supporting coding related, RAC, other external coding reviews, and denials related to coding.

Qualifications

• Bachelor’s degree or equivalent combination of formal education and experience.
• CPC – Certified Professional Coder.
• Must have at least five years of experience in coding; experience must include education/mentoring/training.
• Minimum of five years acute care hospital experience coding with ICD-10-CM and CPT-4, academic medical setting or trauma center preferred.
• Minimum of three years management experience required; five years preferred.
• Prior experience working claim edits and denials.

Requirements

• Excellent command of the ICD-10-CM and CPT4/HCPCS coding conventions, E&M coding.
• Strong knowledge of health records, computerized billing and charging systems, Microsoft applications, data integrity, and processing techniques required.
• Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.
• Ability to work with accuracy and attention to detail.
• Ability to solve problems appropriately using job knowledge and current policies/procedures.
• Ability to work cooperatively with members of the healthcare delivery team and staff.
• Must be able to maintain strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations.
• Must possess extensive knowledge of hospital inpatient and outpatient reimbursement methodologies.
• Ability to mentor, guide and motivate direct reports through demonstration of best practices and leading by example.
• Must possess extensive knowledge of payer claim edits and payer denials.

Benefits

• Generous total compensation that includes benefits (medical, dental, vision, pharmacy).
• Discretionary annual bonuses and merit increases.
• Flexible Spending Accounts.
• 403(b) savings matches.
• Paid time off.
• Career advancement opportunities.
• Resources to support employee and family well-being.

Company Description

Boston Medical Center (BMC) is more than a hospital. It’s a network of support and care that touches the lives of hundreds of thousands of people in need each year. It is the largest and busiest provider of trauma and emergency services in New England. Emphasizing community-based care, BMC is committed to providing consistently excellent and accessible health services to all—and is the largest safety-net hospital in New England. The hospital is also the primary teaching affiliate of the nationally ranked Boston University School of Medicine (BUSM) and a founding partner of Boston HealthNet – an integrated health care delivery system that includes many community health centers. Join BMC today and help us achieve our Vision 2030 which is a long-term goal to make Boston the healthiest urban population in the world.