Manager

• Nemours is seeking a Manager of Hospital Coding and Billing! The Manager is responsible for timely, accurate and compliant charge capture and billing by daily management of key process indicators for revenue which include assuring all encounters are order-based, coded with payer specific requirements, and contain all charge related revenue appropriate for each encounter within 5 days. This includes tracing charges back to the point of origin (i.e., system generated charge; flow sheet generated charge; associate generate charge) and developing countermeasure(s) to prevent future occurrences, which includes education at point of workflow failure to reduce denials and missed revenue.
• Responsible for budget associated with coding and billing functions, training of local staff and home office collaborators.
• Responsible for accurate charge capture of all revenue generated clinical areas (i.e. Pharmacy, Blood Bank, Bedside Procedures, Emergency Department)
• Responsible for accurate ICD 10 CM, CPT, and ICD 10 PCS coding integrity to assure the assignment is accurate, relevant, and uniform.
• Attends all charge capture and hospital coding meetings to evaluate documentation and charge gaps in final claim adjudication process.
• Analyzes high-risk encounters for accurate charge capture of all ordered diagnostic tests with focus on Blood Bank, Laboratory, Cardiac Catheterization, Interventional Radiology, Imaging, and Respiratory.
• Teaches, coaches and mentors all hospital coding and billing staff to work collaboratively, and decisively including succession plan rounding with staff.
• Promotes the Single Path Coding concept by education coders and providers on documentation capture accuracy and requirement to “re-authorize” CPT codes when the surgery data is updated.
• Understand complexity of billing requirements as it related to payer forensic audit and incorporates payer specific trends into day-to-day secondary reviews to reduce “take backs” associated with un-clear, or un-substantiated care rendered.
• Reviews all hospital denials to ascertain whether, or not services rendered are supported with clear documentation, evidence-based logic, and clinical concomitant attributes.
• Responsible for monthly DNB goal < 5 days.
• Bachelor’s degree required or equivalent work experience in lieu of degree
• One certification(s)- RHIA, RHIT, CCS, CDIP, or CPC required
• Epic CDM Certification, Epic Resolute Certification preferred

Manager, Hospital Coding and Billing

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About the role

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