As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
The Senior Director of Coding Quality is responsible for the strategic and day-to-day leadership of Coniferâ��s PRCM Coding Quality Program including vendor selection and oversight, team leadership, data analytics, and client communications.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Directs daily Coding Quality operations to SOW requirements and client expectations. Escalates potential coding quality trends and concerns to Conifer leadership and Compliance, where appropriate
Continually assesses and improves the business unitâ��s financial and operational performance through data analysis and implementattion of sustainable performance improvement initiatives.
Works proactively and collaboratively with Procurement, Coding Compliance and other stakeholders to ensure that the coding quality of all Conifer third-party vendors meets or exceeds Conifer coding quality standards,
Interfaces directly with internal and external clients for reporting responsibilities, prepares all necessary periodic reporting for clients and Conifer governing bodies, ensures compliance with the Guidance is being upheld in every respect regarding billing, coding and claims submission,
Serves as a subject matter expert and resource for information and clarification on accurate and ethical coding and auditing processes and demonstrates a thorough knowledge of coding guidelines, governmental regulations, and third party billing requirements and is able to compare/contrast the guidelines/rules/regulations in order to discern which apply to the audit being performed. Interprets the often complex clinical content of a patient record including the most complicated medical diagnoses and surgical procedures.
Provides input regarding departmental budget specific to area of responsibility.
Reviews and approves expense reports for direct reports.
If direct report positions are listed below, the following responsibilities will be performed in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
Coding Quality Auditors
Coding Quality Senior Auditor(s)
KNOWLEDGE, SKILLS, ABILITIES
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.
Strong leadership and communication skills, problem solving and analytical abilities; good knowledge of medical records systems
Ability to build and maintain teamâ��s dynamics
Serve as a resource to Conifer and client contacts
Advanced knowledge of ICD-10-CM, and CPT and HCPCS coding principles and rules
Advanced knowledge of disease pathophysiology and drug utilization
Advanced knowledge of RVU classification and reimbursement structures
Advanced knowledge of APC, OCE, NCCI, MUE classification and reimbursement structures
Advanced knowledge of the functions of physician offices, medical clinics, and third-party medical companies
Keeps abreast of new technology in coding and abstracting software and other forms of automation and stays informed about transaction code sets, HIPAA requirements and other future issues impacting the coding function
Experiance managing of offshore coding vendor operations, including vendor-specific understandings of processes, technologies, strengths, and opportunities for improvement
Ability to drive high performance and quality from offshore coding vendors
Ability to work under deadlines and juggle multiple projects
Ability to work independently and as part of a team
Ability to multitask with flexibility of daily priorities
Ability to create executive level deliverables and presentations
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
Ten (10) years of recent experience in relevant coding or coding staffing leadership work in the field
Five (5) years of previous relevant management experience related to coding and auditing functions
Five (5) years of previous experience managing offshore third-party coding vendors on coding productivity, coding quality, and vendor quality.
Documented coding and auditing experience.
Experience with ICD-10-CM/PCS, CPT, HCPCS, and CDI
Bachelors or Associate degree in Health Information Management /Technology required
Masters Degree in Health Information Management, Business Administration or other relevant filed strongly preferred
CERTIFICATES, LICENSES, REGISTRATIONS
Required: Current RHIA or RHIT, CCS-P, or CPC credential
AHIMA ICD-10-CM Trainer preferred
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.
Must be able to efficiently use computer keyboard and mouse to perform coding assignments
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Office Work Environment
Capacity to work independently in a virtual office setting or at hospital, clinic, or physician office setting if required to travel for assignment
Must be able to travel nationally up to 25% - Duties may require travel via, plane, car, train, bus, taxi-cab, etc.
Job: Managers and Directors
Primary Location: Frisco, Texas
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Internal Number: 2105025131
About Conifer Health Solutions
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.