Clinical Coding & QA Manager
Purpose of the Position
The Manager of Clinical Coding & QA plays a critical role overseeing the performance of all medical coding functions to ensure optimal use of available resources while achieving peak levels of efficiently and accuracy while maintaining strong relationships between the physician practice, patients and insurance companies. This position directly impacts the revenue cycle.
Working for the oldest and largest non-profit, outpatient healthcare provider on the California Central Coast, the Manager of Clinical Coding & QA is a key member of the revenue cycle management team.
- Plan, organize, and implement coding department processes and procedures for continuous improvement in efficiencies and training.
- Serves as a SME (Subject Matter Expert) for all Medical Coding functions.
- Responsible for the daily supervision of medical coding staff including reviewing daily edits volume, communicates with staff to maintain proper timeliness.
- Reviews edit work files, and makes recommendations for changes, additions, and deletions.
- Works closely with staff and Physician Liaisons to coordinate education, audits, and revenue enhancing opportunities with Providers.
- Works closely with Director of Revenue Cycle and Department Managers to create and execute strategies to reduce denials and payment delays.
- Identifies trends and patterns in medical coding practices and supports staff to implement respective improvements.
- Maintains quality control of medical coders edits, to insure accuracy and adherence to system edits. Develop medical coder production standards and support staff in achievement.
- Completes special projects as assigned.
- Completes annual performance and competency evaluation process with management and participates in goal setting, performance improvement and educational training as needed.
- Participates in professional development activities and maintains professional affiliations.
- Attends required meetings and participates in committees as requested.
- Knowledge in CPT, HCPCS, ICD-9, ICD-10, Medicare, and Medicaid rules and regulations.
- Knowledge of healthcare reimbursement, terminology, and regulations.
- Clinical and standard office equipment including computer and telephone
- Problem solving skills including problem identification through solution
- Skillful in establishing and maintaining effective working relationships with co-workers, management, patients, medical staff, and the public. Skill in accepting constructive criticism and giving suggestions in a professional manner.
- Strong collaborator successful working in cross-functional teams
- Excellent written and verbal communication abilities
- Ability to read, write and communicate effectively in English.
- Maintains certification and license requirements and submits required evidence of certification/licensure as needed.
- Exercises discretion and maintains high level of confidentiality.
- Demonstrates sound cost containment techniques.
- Five years of clinical experience and two years of clinical coding experience.
- Billing experience with knowledge of industry billing practices and an understanding of payment methods for all commercial and government insurances.
- CPC required