PACE Coding Manager

• Coding Manager @ San Ysidro CA 92173
• This position is going to be a direct hire/permanent position;
• Hybrid primarily remote with a minimum weekly expectation for onsite presence (1 week onsite in a month or more).
• EDUCATION (Minimum level of education Preferred): Bachelors Degree in Health Information Management Health Care Administration Business Administration or equivalent combination of education and training.
• CERTIFICATIONS/LICENSES REQUIRED: Active and current Certified Procedural Coder accreditation by an accredited organization or college such as the AAPC that meet the state licensure requirements you will be required to maintain coding accreditation
• EXPERIENCE REQUIRED (Minimum level of experience): 5 years of healthcare experience required; at least 3 years of management experience preferred. 3 to 5 years of handson professional coding experience in large multispecialty group 2 years of experience as a trainer / educator to physicians and coders
• CA drivers license with appropriate insurance coverage

Coding Manager

Position Summary:

Responsible for developing implementing and maintaining risk adjustment functions and processes for San Diego leading a team of coding auditors and facilitating the improvement in overall quality compliance completeness appropriateness and accuracy of documentation and coding for professional services.

While reporting to the San Diego Finance Director will work collaboratively with operations and clinical leadership to improve coding and documentation performance.

Essential Functions of the Job:

• Responsible for developing implementing and maintaining risk adjustment functions and processes for San Diego PACE to facilitate improvement in overall quality completeness appropriateness and specificity of documentation.
• Hire lead train and oversee a successful team of coding auditors and manage their performance to create a cohesive and highly effective team.
• Contribute actively to new clinical program development through creation of training tools resources procedures and workflows for providers and San Diego PACE coding auditors.
• Educate train onboard and communicate effectively with the team of providers on accurate complete and compliant documentation and coding practices and hold regular and episodic provider training initiatives.
• Assess current compliance activities and evaluate risk factors in coding and documentation practices and implement strategies to mitigate risk by educating providers and coders.
• Responsible for timely review of all billable encounters prior to claims submission for accuracy and completeness and comprehensive concurrent coding reviews and audits of a subset of encounters with emphasis on documentation quality accuracy completeness compliance and specificity.
• Establish implement and maintain a formalized review process for coding and documentation compliance including a formal audit process and quality control.
• Communicate with the providers in real time prior to claims submission or redaction through coding queries regarding need for clarification amendment or modification of specific patient encounters following compliant practices to optimize documentation accuracy specificity and completeness.
• Work with the provider team and center operations on timely closure of encounters and completion of tasks related to documentation and coding practices.
• Oversee successful and timely biannual creation of redaction and submission Risk Adjustment Processing System (RAPS) files to the Center of Medicare and Medicaid Servicer (CMS).
• Contribute to successful transitions of vendors including Electronic Health Records to minimize potential burden and vulnerabilities and improve clarity of expectations pertinent to documentation and coding practices including development training and implementation of new workflows and processes for the impacted teams.
• Meet with external vendors and internal resources and stakeholders monthly to review coding analytics dashboards and reports gain a deep understanding of current and past performance identify trends opportunities and future strategies and communicate those with the San Diego PACE leadership team and ensure necessary actions are taken by appropriate teams and individuals to address gaps in performance.
• Stay current with Official Coding and Reporting Guidelines CMS and other agency directives for ICD10CM/PCS and CPT coding and serve as a Subject Matter Expert to collaborate and communicate existing and new guidelines with other departments such as medical practice operations and finance.
• Routinely reevaluate existing workflows to identify opportunities for improvements standardization or reeducation to increase efficiency and accuracy of documentation and coding for all services and providers.
• Serve as a resource to bridge the gaps between the clinical providers and coders and facilitate resolution of documentation and coding issues.
• Provide timely feedback to the coders and auditors and take corrective action to ensure highly effective practices.
• In collaboration with Coders and PACE Finance Director periodically reviews reimbursement trends by Hierarchical Condition Category (HCC) codes to evaluate opportunities and identify payment issues making recommendations for changes as necessary.
• Proficient with ICD10 and CPT coding as well as E&M and all professional codingguidelines for large multispecialty provider groups

Additional Duties and Responsibilities:

• Stays current with Official Coding and Reporting Guidelines CMS and other agency directives for ICD10CM/PCS and CPT coding. Completes online education courses and attends mandatory coding workshops and/or seminars.
• Provide direction management and supervision to ensure efficient operation of assigned departments.
• Coordinate with Other PACE departments to develop standardized processes and gain systemwide efficiencies.
• Function as a crossfunctional collaborator build trust and communicate effectively with central and sitespecific leadership stakeholders and providers throughout the organization.

Job Requirements:

Education (Minimum level of education Preferred):

• Bachelors Degree in Health Information Management Health Care Administration Business Administration or equivalent combination of education and training.

Certifications/Licenses Required:

• CA drivers license with appropriate insurance coverage
• Active and current Certified Procedural Coder accreditation by an accredited organization or college such as the AAPC that meet the state licensure requirements you will be required to maintain coding accreditation.

Experience Required (Minimum level of experience):

• 5 years of healthcare experience required; at least 3 years of management experience preferred.
• 35 years of handson professional coding experience in large multispecialty group
• 2 years of experience as a trainer / educator to physicians and coders

Verbal and Written Skills Required to perform the Job:

• Good written and verbal communication.
• Strong communication and presentation skills preferably comfortable speaking with people at an executive level or physician level
• Working Traits: Superb organizational ability and exceptionally analytical.

Technical Knowledge and Skills Required to Perform the Job:

• Experience and knowledge with Microsoft Office software.
• Equipment Used: Companys Laptop occasionally personal phone.

Working Conditions and Physical Requirements:

• Long Irregular hours.
• May work weekends.
• Prolonged periods of sitting and constant walking and standing.
• Driving and occasional travel required.