Professional Services - Coding Manager
Our goals are to provide excellent service, utilize advanced technology, and proficiently deliver results. To accomplish these goals, we constantly seek individuals who look for ways to do things better. We are a company whose
cultivates teamwork, rewards excellence, focuses on quality for every aspect of our business, and promotes community involvement.
Tabula Rasa HealthCare (TRHC) is a leader in providing patient-specific, data-driven technology and solutions that enable healthcare organizations to optimize performance to improve patient outcomes, reduce hospitalizations, lower healthcare costs, and manage risk. Medication risk management is TRHC’s lead offering, and its cloud-based software applications, including EireneRx® and MedWise™, provide solutions for a range of payers, providers and other healthcare organizations.
TRHC empowers our employees to provide excellent service, utilize advanced technology, and proficiently deliver results. Our 32Fundamentals are what we are and who we are. Our culture cultivates teamwork, rewards excellence, focuses on quality for every aspect of our business, and promotes community involvement. As a part of our team, you will help us bring innovative service models to healthcare, improving patient outcomes.
This position performs highly technical and specialized functions for Tabula Rasa Healthcare. The coding manager is responsible for the organizational and functional integrity of the coding services, ensuring staff compliance, development and education. The manager assists in the coordination and supervision of day to day operations within professional coding functions under the Director of Coding and Auditing.
ESSENTIAL JOB FUNCTIONS:
- Oversees activities of the professional medical coders to ensure compliance with departmental policies, standards, procedures and applicable regulatory requirements.
- Teach, support, counsel, coach, evaluate and serve as a role model for all medical coders and assists staff as needed to complete work and ensure all expected standards in the process are working optimally. Problem solves, troubleshoots and appropriately escalates issues to higher level management (Director of Coding and Auditing) as necessary.
- Responsible for new client implementations and to ensure all workflow processes and business rules, with all nuances, are clearly captured and documented.
- Provides education and training to existing and new employee (coders) staff.
- Uses training in the anatomy and physiology of the human body and disease processes to understand the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and procedures to be coded and to provide direction and mentoring of staff to ensure their understanding of coding principles and correct coding initiatives.
- Performs clinical validation audits and interpretation of medical documentation to ensure capture of all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives
- Provides clinical interpretation and guidance to clients.
- Collaboration with other Capstone teams to provide as needed and quarterly education to clients.
- Oversees quality audits to assure consistency, accuracy and standardization of procedures and optimize medical coding. Provide re-training or action plans as needed to improve accuracy and production standards.
- Provides feedback and process improvement recommendations to appropriate health plan operations departments and participates in workgroups/committee meetings and process improvement solutions as required.
- Advises Director of possible trends in inappropriate utilization (under and/or over) and other quality issues.
- Participates as requested in department meetings, client calls, and performance evaluation and management.
- Assigns float coding coverage for PTO, backlog, special projects, etc.
- Develop and implement organizational policies and procedures for the coding team. Prepares RAPS submissions monthly for assigned clients.
- Maintain communication between the coding team by coordinating monthly coding team organizational meetings.
- Determines and monitors staffing matrix to assign workloads and optimize productivity and meet department standards.
- Responsible for reviewing and approving team member timesheets and PTO requests.
- Performs other functions as required.
EDUCATION AND CERTIFICATION:
Bachelor’s Degree preferred; Minimum Associate Degree
Professional Medical Coder Certification required: Certified Coding Specialist designation (CCS) issued by the American Health Information Management Association; or, Certified Professional Coder (CPC) and Registered Health Information Administrator (RHIA), or Registered Health Information Technologist (RHIT) with 6 months experience coding ICD-10 CM.
In addition to the above, also must have (CRC) Certified Risk Adjustment Coder certification.
EXPERIENCE & TRAINING:
- Minimum four years of experience in Hierarchical Condition Categories (HCC) or risk adjustment.
- Minimum four years’ experience providing clinical documentation Improvement training
- Minimum 2 years management experience
- Proficient with MS Word, Excel, PowerPoint, and Comfortable with learning and becoming an expert on new and proprietary software.
The Company is proud to be an equal opportunity employer. All qualified applicants will receive consideration without regard to ancestry or national origin, race or color, religion or creed, age, disability, AIDS/HIV, gender, marital or family status, pregnancy, childbirth or related medical conditions, genetic information, military service, protected caregiver obligations, sexual orientation, protected financial status or other classification protected by applicable law.
- Pay Type Salary