Director of Coding - Auditing & Compliance
ETSU Physicians & Associates, Johnson City, TN
Applicants should apply online at: https://etsuhealth.org/employment
SUMMARY: Under supervision of a member of the executive team, the Director of Coding is responsible for managing, directing, and coordinating coding operations and support of coding functions across the organization. This will include overseeing the work of the medical coding staff, patient’s medical records, and assigning the correct codes meeting the standards of AAPC. This will include compliance, education and auditing with developing coding standards and policies, conduct training sessions, review coding performance, and serve as a resource for physicians, residents, and other staff members at ETSU Health involved with billing third-party payers. Specifically, build standards around remote workers for accuracy, production expectations, limiting denial rates, and process improvements. This position is responsible for the strategic direction of coding, compliance, revenue cycle and improved accuracy and efficiency of the department and the providers across the organization as one unified department.
ESSENTIAL DUTIES AND RESPONSIBILITIES may include overseeing the following: Other duties may be assigned.
• Perform annual audits of documentation of inpatient and office medical records by physicians, residents, nurse practitioners and other providers.
• Educate the physicians, residents, nurse practitioners and other providers of coding and documentation issues based on the audits.
• Report audit results to the Executive Team, Compliance Committee, and Board of Directors as appropriate.
• Provide coding and documentation guidelines to the physicians, residents, nurse practitioners, and billing employees as needed.
• Provide an orientation to all new hire physicians on the compliance plan and policies, teaching physician guidelines, as well as conduct an initial audit on billing within first 90 days of a new provider.
• Research problem areas and provide solutions related to coding and reimbursement.
• Provide quarterly education to each department provider related to opportunities, denials, and changes within reimbursement by payers.
EDUCATION AND/OR EXPERIENCE: Associate’s degree required, bachelor’s degree preferred, and master’s degree highly preferred. CPMA certification required. Knowledge of CPT, ICD-10-CM and HCPCS coding systems and guidelines. Basic knowledge of HIPAA guidelines necessary. Experience in an academic and/or multi-specialty environment
preferred. Knowledge of medical terminology, physician billing, third-party regulations, and auditing procedures. CCS, CPC, ART or RRA required, plus 5 years of coding and billing experience. Previous auditing experience and leadership is required.
QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
LANGUAGE SKILLS: Ability to read, interpret, and comprehend simple instructions (whether written or verbal). Ability to compose simple correspondence and documentation. Ability to effectively present information and respond to questions in one-on-one and small group situations to patients, third parties, physicians, and other employees of the organization, whether in person or on the telephone. Ability to respond to inquiries in a manner that the respondent can comprehend. Ability to respond effectively to the most sensitive inquiries, complaints, and situations.
MATHEMATICAL SKILLS: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and other routine mathematical functions.
REASONING ABILITY: Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret and solve practical problems with an extensive variety of information that deals with several variables. Ability to apply common sense, good judgment, and problem-solving skills in situations.
OTHER SKILLS AND ABILITIES: Working knowledge of computers, keyboards, and printers. Skill in composition, compiling, and preparing a variety of correspondence, documentation, reports, and other materials. Ability to establish and maintain an effective working relationship with faculty members, staff, patients and other third parties. Ability to concentrate under high demands and listen effectively. Ability to organize tasks, work as a team member and independently with a variety of professional disciplines. Convey a professional and positive image and attitude.
WORK ENVIRONMENT: The work environment characteristics are representative of those an employee encounters while performing the essential functions of this job within a medical office. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.
PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to stand, walk, sit; use hands and fingers to handle or feel objects; reach with hands and arms; and talk or hear at normal ranges within the setting. The employee occasionally is required to bend, stoop, kneel, crouch, and/or crawl. The employee is occasionally required to climb or balance.
The employee must occasionally lift, carry, and/or move up to 25 pounds.
Specific vision abilities required by this job include depth perception and the ability to adjust focus. Rapid mobility may also be required on occasions.
Stress levels may be high due to frequently dealing with numerous patients, physicians, family members, and other healthcare providers. Demands concentration and the ability to work in emotionally charged situations.