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Medical Coding Manager

Company: Lake County IL
Location: Waukegan
Posted on: June 21, 2022

Job Description:

General Description As the largest human service provider in Lake County, we believe that services must be available without barriers. No residents are turned away due to the inability to pay. We believe in providing services in an environment of mutual respect, free of discrimination or bias. Whether assuring accessible and effective care, impacting policy, or assessing and monitoring risks, the Lake County Health Department and Community Health Center has been an essential part of the public health system in Lake County for 60 years. We are looking for passionate, qualified team members, who can help make a difference in our agency, and most importantly, in our community. Summary This position will oversee the daily operations of medical, dental, behavioral and chemical dependency coding team. This role is responsible for the management and supervision of the Medical Coding Specialists, development and maintenance of a comprehensive coding education program as well as coordinating Quality Assurance Reviews and compliance audits. The role conducts independent and collaborative audits according to the compliance work plan and develops appropriate documentation to support audit work performed. Provides feedback from audit results for documentation and coding quality improvement. In addition, this role is responsible for developing an educational pathway for Providers, and Medical Coding Specialists. This role will work closely with the Revenue Cycle Manager to drive in "front end" workflows and business processes. Also, works closely with EMR specialists to ensure standardization and workflow consistency/compliance. Performs work of considerable difficulty and works in a highly independent role. Scheduled Hours: 40 hours a week * Monday-Friday (8:00am-5:00pm) Essential Functions * Supervises Coding Group of medical and coding personnel including hiring, onboarding, ongoing training, ensuring active credentials, and performance management as well as improves workflow and productivity of the coding team.
* Acquires and utilizes knowledge of the LCHD/CHC NextGen system in order to accurately and effectively coordinate requirements between the LCHD providers, Central Billing Office and the funding agencies.
* Lead or participate in cross-functional workgroups/committees as needed to represent coding issues.
* Assists with the onboarding and ongoing training of new physicians and other staff, in regard to coding, billing staff for claim resolution and coding staff, following established processes and collaborating with the appropriate functions to ensure success.
* Assists in policy and procedure creation, updates, and revisions
* Effectively utilize ICD, CPT/HCPCS and related materials to investigate coding issues and produce accurate results
* Works collaboratively with medical, nursing, ancillary, and coding team to improve the quality of chart documentation, identifying any need to clarify documentation in the medical record, which includes direct communication with clinical staff.
* Understand Medicare billing rules (i.e. LCD/NCD, CCI, Medical Necessity, and ABN) and communicate this information to staff, and physicians.
* Assist with any system template changes needed to support medical coding and billing requirements determined by Medicaid, Medicare, Managed Care, private insurance, state payers like Department of Mental Health, Family Planning and other third party payers
* Monitor regulations for updates and changes, providing education as necessary.
* Analyzes HEDIS provider data, develops recommendations for provider education, patient outreach efforts to support HEDIS initiatives.
* Uses the NextGen patient management system, electronic health records, crystal reports, and personal computer spreadsheets to create reports
* Coordinates external audits, report findings and implement process improvement.
* Monitor services performed to ensure all encounters are captured, coded and billed within timeframes
* Work with the Revenue Cycle Manager to resolve payer denials and implement processes to ensure accurate reimbursement
* Conduct system testing, provide feedback, and support conversions/implementations on coding
* Develops and performs audits to help determine and validate documentation and coding issues and gaps; analyzes audit results and identifies patterns, trends and variations in coding and documentation practices; and makes recommendations for improvement.
* Performs coding functions as needed to maintain coding skills and maintain a comprehensive understanding of the coding workflows.
* Actively participates in meetings and/or seminars and disseminates the information to peers to enhance the knowledge and skills of the department. Knowledge Skills Abilities and Education Required * Bachelor's degree and five (5) years of progressively complex coding work experience and training delivery OR
* Associate's degree and eight (8) years of progressively complex coding work experience and training delivery with a large and diverse FQHC medical, dental and behavioral health outpatient practice.
* Five (5) years of supervisory experience.
* Expert outpatient coding knowledge, including in-depth understanding of coding guidelines, conventions, CPT, and Evaluation and Management classification systems and knowing how to utilize resources available.
* Experience with the electronic health record and health care applications required. NextGen experience preferred.
* Certified Coding Specialist (CCS or CCS-P) or RHIT, through the American Health Information Management Association (AHIMA) or Certified Professional Coder (CPC) through the American Academy of Professional Coders (AAPC) is required.
* High level of competency with Microsoft Office tools.
* Advanced knowledge of disease processes, ICD-10, CPT and HCPCS coding applications, clinician documentation of government regulations and areas of scrutiny for potential fraud and abuse.
* Ability to review analyze and interpret billing guidelines and state and federal regulations.
* Ability to create training material and presentations. Supplemental Information You can find additional information about the Lake County Health Department, our culture, and why you should join our team at As a public health department, we believe in the science, data, and power of vaccines, like the influenza and COVID-19 vaccines, to protect against and prevent illness. Therefore, we require all Health Department staff to receive the primary series of the COVID-19 vaccine as well as the annual influenza vaccine unless they have an approved medical or religious exemption. Any offer of employment is conditioned on the successful completion of a background screening, drug and alcohol testing and may include a pre-employment medical exam. The Lake County Health Department and Community Health Center is an Equal Opportunity Employer. We evaluate qualified applicants without regard to race, color, religion, sexual orientation, gender identity or gender expression, national origin, disability, veteran status, and other protected characteristics.

Keywords: Lake County IL, Waukegan , Medical Coding Manager, Executive , Waukegan, Illinois

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