POSITION PURPOSE

Manages, directs and provides leadership and strategic oversight of the Trinity Health Medical Group’s (THMG) Regional Professional Coding team.  Partners with auditing, billing, finance, and operations to promote coding accuracy and adherence to local ministry and regional Trinity practices and policies.   Design and builds structure, workflows, and guidance for resolve of coding issues in charge router, charge review and claim edit WQs assigned to regional coding team to ensure coding compliance and minimize audit liability.  Provides emphasis on adherence to CMS and other insurance carrier standards, optimizing revenues and the avoidance of monetary settlements from third party audits.

ESSENTIAL FUNCTIONS

• Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.
• Provides leadership and manages the work of assigned regional staff, including the monitoring of staff competencies, hiring of new staff, orientation of new assignments, developing goals and objectives, conduction of annual performance appraisal and the utilization of performance resolution process, including performance improvement plans and corrective action, as needed.
• Works with providers and ambulatory practice leaders to develop accurate, effective, efficient, and compliant charge capture and coding processes that ensure revenue is recorded for all services provided and clinical documentation exists to support all charges and coding assigned.
• Ensures systems and processes comply with federal, state and payer-specific coding, billing and reimbursement guidelines.
• Identifies patterns and trends impacting coding and reimbursement to coordinate with THMG Revenue Cycle Site Operations, Professional Billing, Auditor, and Educators, EPFS, and Professional Revenue Integrity educational materials and payer communications to ensure coding accuracy.
• Oversees coding and charge capture reconciliation with Regional Professional Coding Supervisor(s).
• Manages team compliance to initial and ongoing audit recommendations, ensures educational materials and programs are available to staff, and safeguards are in place to promote accuracy.
• Assists in the development of software applications in assigned areas to resolve simple and complex issues and aligns action plans with local and Trinity goals and objectives.
• Monitors daily trends to help guide Revenue Site Operations leadership team with targeted areas for improvement to achieve THMG top performance metrics and minimize Charge Router, Charge Review and Claim Edits dollars in Pre-AR and AR.
• Works with Informatics leadership to identify and resolve trends with process gaps causing errors in charge capture and provider compensation.
• Works closely and collaborates with assigned THMG region’s Finance, Operations, and Practice Leaders, Providers, C-Suite Payer Strategies, EPFS and other regional leaders and colleagues across the organization.
• Responsible for Regional Professional Coding departmental budget.
• Motivates staff to achieve the highest levels of performance, working in conjunction with all key stakeholders to prevent revenue leakage and maximize potential revenue for the region.
• Optimizes staff and overall revenue performance through process redesign, policy/procedure implementation, communications, continuing education and professional development activities, staff empowerment and feedback.
• Attends coding and reimbursement workshops and webinars; communicates related information to appropriate departments and ensures understanding and assists with applicable process or system changes as needed.
• Establishes and monitors key performance measures and targets to achieve optimal performance; ensures placement of appropriate internal controls; and employs corrective action to remedy problems or shortfalls.
• Other duties as needed and assigned by the director.
• Maintains a working knowledge of applicable Federal, State, and local laws/regulations, the Trinity Health’s Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

MINIMUM QUALIFICATIONS

• Must possess a comprehensive knowledge of CPT, ICD-10-CM (ICD-9-CM) and HCPCS level II coding guidelines, along with CCI edits and Medicare claims processing manual contents in a multi-facility, integrated health care delivery system or revenue cycle or consulting experience, as normally obtained through a bachelor’s degree in related field and five (5) to seven (7) years of progressively responsible experience in revenue cycle operations or equivalent combination of education and progressive revenue cycle experience.
• Current standing as a Certified Professional Coder (CPC) or RHIT.
• In addition to CPC or RHIT, Certified E&M Coder (CEMC), and/or Certified Risk Adjustment Coder (CRC) preferred.
• Minimum of three (3) to five (5) years of management experience in a multi-facility, integrated health care delivery system, revenue cycle, or consulting experience.
• Four (4) to six (6) years of experience in multi-specialty coding, with comprehensive knowledge of Medicare, Medicaid, and other third-party billing rules and regulations.
• Proficiency in Microsoft Office, including Outlook, Word, PowerPoint, and Excel.
• Ability to work collaboratively in a team-oriented environment with a strong customer-service orientation.
• Ability to maintain confidentiality of patient and organizational information.
• Ability to prioritize and organize work effectively.
• Ability to exercise independent judgment as appropriate within standard practices and procedures.
• Ability to inspire and motivate others to perform well; accepts feedback; gives appropriate recognition.
• Ability to approach conflict in a constructive manner.
• Ability to identify problems, offer solutions, and participate in their resolution.
• Maintains professional development and growth through journals, professional affiliations, seminars, and workshops to keep abreast of trends in revenue cycle operations and healthcare in general:
• Participates as appropriate in continuing educational programs and activities that pertain to healthcare and revenue cycle management, as well as specific functional areas.
• Develops and implements an annual plan of personal and professional development.
• Participates in local, regional, and national health care revenue activities and professionally represents Trinity Health at these functions.
• Serves in a leadership role and promotes positive Human Resource Management skills:
• Fosters teamwork atmosphere between business and clinical stakeholders.
• Retains, recruits, and manages staff to achieve strategic objectives; and
• Provides staff training and mentoring.
• Good organizational and time management skills to effectively juggle multiple priorities and time constraints.
• Ability to exercise sound critical thinking, problem-solving and decision-making skills.
• Effective verbal, written, and interpersonal communication skills with the ability to comfortably interact with diverse populations.
• Ability to work remotely from home following Trinity remote work guidelines.
• Must be comfortable operating in a collaborative, shared leadership environment.
• Must possess a personal presence that is characterized by a sense of honesty, integrity and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals and values of Trinity Health.

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS

• This position operates in a remote environment.
• Incumbent communicates frequently, in person and over the phone, with people in all locations on product support issues.
• Manual dexterity is needed to operate a keyboard. Hearing is needed for extensive telephone and in person communication.
• The environment in which the incumbent will work requires the ability to concentrate, meet deadlines, work on several projects at the same time and adapt to interruptions.
• Must be able to set and organize own work priorities and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles.
• Ability to thrive in a fast-paced, multi-customer environment, with conflicting needs which some may find stressful. May warrant varied and/or extended hours, with changes in workload and priorities to keep pace with the industry and advance strategic priorities.
• Must be able to travel approximately 25% of the time as may be needed in the region. This may include travel to THMG locations outside of the Region and to the System Office as may be necessary.
• Must possess the ability to comply with Trinity Health policies and procedures.

The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification. They are not to be construed as an exhaustive list of duties so assigned.