HIS - Professional Coding Integrity Supervisor

PURPOSE OF THIS POSITION

The primary purpose of the Professional Coding Integrity Supervisor is to maintain the daily operations of the Professional Coding Integrity Specialists (PCIS), provide education to providers, offices, and other departments to ensure accurate, compliant and optimal professional charge capture which is supported by clinical documentation. Coordinate with the Professional Coding Integrity Auditor / Educator to research coding questions from offices, departments, and providers. Supports the PCIS job functions as necessary. Provides general coding support as well as education and training for new and existing BVHS providers.

JOB DUTIES / RESPONSIBILITIES

• Duty 1 : Provide direct oversight of the PCIS team and related functions with the primary objective to support the integrity of the professional charge processes by ensuring capture of all revenue opportunities and compliance with applicable regulatory standards.  Effectively communicate and solicit input from team and other impacted areas to promote a collaborative and innovative team environment, translates BVHS Mission, Vision, and Values into front-line action. Maintains effective connectivity and collaboration between all members of the team, including onsite and remote associates.
• Duty 2 : Perform supervisory administrative support functions including but not limited to : assist in the recruiting and hiring process, training and education of associates in conjunction with the professional coding integrity auditor / educator when needed, coordinate staff schedules, payroll,  completion of associate performance evaluations, recognition and reward, disciplinary follow up as appropriate, monitor adherence to established quality and productivity standards and department metrics, support associate, departmental and organizational goals, assist in the development and monitor completion of competencies and organizational mandatory requirements, etc.
• Duty 3 :   Identify clinical documentation opportunities and provide routine feedback and education to medical staff providers to support compliant, accurate and optimal charge capture. Provide education in a meaningful and organized approach which is supported by examples, research, potential revenue impact, and / or tools to support the provider.  Communicate with electronic health record (EHR) Trainers, Superuser or Analyst to explore potential options to improve quality and ease of provider documentation.
• Duty 4 : Remain current on regulatory guidelines related to CPT and ICD-10 coding updates. Serve as primary resource for providers and the revenue integrity team for guidance relative to professional-related coding issues and / or clinical documentation practices.  Provide research as necessary and collaborate with various team members or other departments to provide accurate and credible guidance.
• Duty5 : Review of quarterly internal quality audits of the PCIS team, in coordination with the auditor / educator; assist in building education plans, feedback and documented education to the PCIS regarding the results and areas of opportunity for improvement.
• Duty 6 : Work with the Compliance Department, in coordination with the Professional Coding Integrity Manager to assist in response to investigational or potential compliance risks.
• Duty 7 : Work with Coding Claims Resolution Specialist (CCRS) to review denial trends, whether coding related or other, and prepare feedback for improvement opportunities for the appropriate audience. Work in conjunction with auditor / educator as well as CCRS to review pre-bill edits & tracking sheets and collaborate on opportunities for education and training when available.
• Duty 8 :   Monitor PCIS work queues and reassign encounters as needed to maintain a manageable level of encounters for each PCIS or contract coder as needed. Coordinate with additional resources, as necessary, such as Revenue Integrity Auditors and / or Coding Integrity Team, when available, to assist with the review and release of encounters. Organize cross-training with educator / auditor to develop depth of skills within the team.
• Duty 9 :   Demonstrate superior knowledge of federal, state and third-party charging guidelines of clinical areas supported by the Professional Coding Integrity team to ensure optimal, accurate and compliant charging. Understand changes to applicable coding and billing regulations, including annual IPPS / OPPS revisions, by resourcing credible references (i.e. CMS website, Craneware, Codify, publications, professional contacts, reliable internet sources, seminars, etc.). Collaborate with clinical areas, Revenue Integrity Team, Coding Integrity Team and / or other impacted areas to support implementation of changes.
• Duty 10 :   Participates in system testing as a result of upgrades, changes, enhancements, new application implementations, etc. that may impact Professional Coding Integrity processes.
• Duty 11 : Regularly attends and actively participates in in-services, organizational and department meetings and continuing education programs as offered in order to remain current with organizational and industry changes and best practice. Communicate and disseminate information to other departments as applicable.

REQUIRED QUALIFICATIONS

PREFERRED QUALIFICATIONS

PHYSICAL DEMANDS

This position requires a full range of body motion with intermittent activities in walking, lifting, bending, squatting, climbing, kneeling, and twisting. The associate will be required to sit for five hours a day. The individual must be able to lift ten to twenty pounds and reach work above the shoulders. This position requires corrected vision and hearing in the normal range. The individual must have excellent eye-hand coordination and verbal communication skills to perform daily tasks.