RCM
Job Roles & Responsibilities
- Manage and deliver automation and transition of Coding and other RCM projects
- Delivery of coding work per SOWs, maintain client confidence, expand team in terms of coding capability across multi-speciality and billable resources, improvement in process standards and coder efficiency.
- Team Management – Managing team of 30+ Medical Coding Executives.
- Service Delivery – Meeting production goal, quality benchmark & client SLA on daily and monthly basis.
- Training and Team Building.
- Client Relationship – Implementing resolutions for client complaints
- Effectively controlling team’s absenteeism and attrition.
- Capacity planning as per work inflow.
- Managing Coding for different specialty through the understanding of medical terminology, AMA guidelines, anatomy, physiology and procedures and assigning the appropriate CPT, ICD-10 CM, HCPCs and special access codes based on medical documentation. Associate the diagnosis codes to the appropriate procedure codes (CPT) and sequence the codes in such a way as to insure proper reimbursement.
- Creating SOP’s for new processes and set Coding guidelines by reviewing payer specific guideline, LCD/NCD guidelines. MUE and fee schedules.
- Requires ability to adapt and participate in frequent changes of policies and procedures in response to internal and external requirements.
- Requires ability to maintain accuracy, work independently and resolve problems effectively.
- Analyzing and resolving Coding denials and improve clean claim ratio.
- Applies research, information gathering and analytical skills to complex activities and issues.
- Provides expertise and guidance on technical or procedural issues.
- Develop, implement and monitor policies and procedures, guidelines and compliance plan for coding.
- Provides recommendations for improvement in coding process for continuous quality improvement.
- Tracks and maintains regular and ad hoc reports.
Candidate Requirements
- Strong knowledge and experience of working on Medical Coding automation projects.
- Should be able to coordinate the automation projects between Coding, RCM and programming team.
- Good analytic skills and expertise to be proficient in accurately coding medical records utilizing ICD-10-CM, CPT conventions & HCPCs.
- Strong ability to interpret medical records of the patients in different specialties.
- Ability to communicate, have excellent interpersonal, listening skills and organizational skills.
- Strong ability to interpret LCD/NCD and payer specific guidelines and policies related to Coding.
- Able to handle diverse clients and have experience working multiple Specialties
- Strong verbal and written communication skills to facilitate relationships with medical staff, peers, management, staff and other healthcare personnel
- Ability to take direction from all levels
- HIPAA, PHI, CIRCC and industry compliance knowledge and adherence.
- Minimum 9+ years of experience in medical coding with knowledge base area – Medical Coding automation, medical terminology, anatomy and physiology, multiple specialties, denial management, coding reference manuals, compliance and federal regulations
- Minimum 4+ years of experience in team management and Medical Coding automations as Assistant Manager and/or Manager.
- Coding certification from AHIMA or AAPC is must.
- Graduate from recognized university
- Exhibit a high level of individual initiative
Kindly Note: At Credence, we uphold the highest standards of integrity in our recruitment process. We do not charge any fees at any stage of the hiring process, and we strictly prohibit any third parties, vendors, or individuals from soliciting money in exchange for job opportunities at Credence.
If you are approached by anyone requesting payment or offering you a position at Credence in exchange for money, do not engage with them. Such actions are fraudulent and not authorized by Credence. Please report any such incidents immediately to our official HR team at [email protected]m
Your safety and trust are important to us. Thank you for helping us maintain a fair and transparent hiring environment.