Gastro Health

Operations

• Directly oversees and supervises day to day operations of designated Coding Department teams.
• Prioritize, assess, and re-prioritize daily workflows to ensure timely execution of Coding and meeting/exceeding goals/KPI.
• Assist with creation of front-end scrubs/edits based on coding guidelines and denial management review.
• Effectively manages the team through streamlined improvement initiatives to ensure the team is highly effective for the providers.
• Actively participates and maintain strong new hire training process and assist with policy/procedure documentation and process workflow.
• Conduct audits of team members to ensure quality initiatives are being met and exceeded.
• Identify and document trends in underpayments, denials, aging receivable that compromise the ability of the Coding team to meet established goals.
• Assists with resolution of complex claims or projects and trains team to improve follow up efforts.
• Strong analytical skills to prepare project data with external payors and partners.
• Motivate, train, evaluate, record and report team members performance and progress.
• System matter expert of all Coding functions across the team to maintain a highly efficient and productive team and to ensure process can be trained effectively.
• Assist Management in establishing weekly/monthly goals, ensure Coding team members are utilizing all resources and meeting and/or surpassing weekly/monthly KPI’s.
• Assist manager with preparing weekly and monthly RCM reporting metrics to remediate any items outside established KPI including status report of projects.
• Research and maintain understanding of policy changes across the RCM markets.
• Daily reviews of the following programs: Incoming claim/denial volumes, daily billing, rejections, evaluate clean claim rates, and team workflows.
• Assist manager in the interview process.
• Assist with preparation of team meetings focused on collaboration and process improvement.
• Assist Manager with employee performance appraisals and work with the coding team on skill development.

Coding Operations Lead

• Hands-on management of all billing programs, systems, processes, and third-party vendors to ensure accurate, timely and well-controlled activities related to coding departments
• Prepares weekly and monthly RCM reporting metrics to remediate any items outside established KPI including status report of projects.
• Effectively implement denial management reduction through process improvements, coordinating direct or indirectly, with internal team and offices to improve workflows and provide training and education.
• Maintain understanding and communicates coding guideline changes across the markets
• Meet with Care Center Managers for timely remediation of care center hold items
• Formulate and execute policies and procedures to ensure the billing workflow is highly effective.
• Daily reviews of the following programs: Incoming claim/denial volumes, daily billing, rejections, evaluate clean claim rates, and team workflow.
• Develops quality control program to meet the company’s quality initiatives.
• Ensure productivity goals are monitored and quickly re-mediates barriers to achieving those goals at the individual and/or team level.
• Counsels and disciplines employees in accordance with department goals and policies.
• Concentrated effort to develop and mentor team leads and Coding team members to allow for internal growth.
• Maintain compliance with directives from all regulatory agencies and third parties.
• Lead team meetings focused on collaboration and process improvement.

Coding Operations Manager

• Directly oversees and manages day to day operations Coding Department
• Work closely with management team to prioritize, assess, and re-prioritize daily workflows to ensure timely execution of Coding and meeting/exceeding goals/KPI.
• Evaluate opportunities for creation of front-end scrubs/edits based on coding guidelines and denial management review.
• Evaluate and implement streamlined improvement initiatives to ensure the team is highly effective
• Implement and maintain strong new hire training process
• Evaluate, document, and implement appropriate policy/procedures for coding workflow.
• Ensure audits of team members completed to ensure quality initiatives are being met and exceeded.
• Identify trends in underpayments, denials, aging receivable that compromise the ability of the Coding team to meet established goals and implement resolutions
• Strong analytical skills to prepare project data with external payors and partners.
• Systems expert for all Coding systems used so that the department can maintain a highly efficient and productive team
• Establish weekly/monthly goals, ensure Coding team members are utilizing all resources and meeting and/or surpassing weekly/monthly KPI’s and productivity expectations
• Prepare weekly and monthly RCM reporting metrics to remediate any items outside established KPI including status report of projects.
• Research and maintain understanding of policy changes across the RCM markets.
• Daily oversight of the following: Incoming claim/denial volumes, daily billing, rejections, evaluate clean claim rates, and team workflows.
• Preparation for team meetings focused on collaboration and process improvement
• Understanding of complex interfaces and workflows and ability to quickly identify issues and correct them
• Prepare and report to senior leadership on coding status/KPIs on a weekly basis

Coding Operations Lead

Coding Operations Manager

Director of Coding Operations