Manager Coding and Revenue Integrity

At Houston Methodist, the Manager Coding and Revenue Integrity position is responsible for managing all aspects of coding education, coding and revenue integrity procedures as it impacts the organizations' revenue cycle. This includes planning, monitoring, and directing all activities pertaining to and impacting coding, coding audits, charge capture, and physician onboarding. The Manager Coding and Revenue Integrity position will manage the coding department in relation to the following: staffing, distribution of work assignments, dissemination of current coding and charge capture guidelines and modern technology information, reviews and analyzes reimbursement trends in the community for all departments within the Houston Methodist Physician Organization (PO) and provide education for physicians and revenue cycle staff. The Manager Coding and Revenue Integrity position will be responsible for leading the revenue integrity team to ensure charge capture activities are completed timely and accurately within established guidelines and regulations. Additional responsibilities will include managing, tracking, and facilitating policies and procedures for accurate reimbursement while maintaining patient and physician satisfaction and adherence to compliance policies.



The manager position responsibilities include managing the daily work activities of the work unit/department staff, ensuring quality, productivity, functional excellence and efficiency while assisting management in accomplishing strategic and operational objectives. In addition, this position provides guidance to staff and is responsible for staffing, budget compliance, contributing to staffing decisions such as hiring and terminating employment, coaching and counseling employees on work related performance, and assisting in the development and implementation of policies and procedures to ensure a safe and effective work environment. This position also implements training, monitoring and operations initiatives that secure compliance with ethical and legal business practices and accreditation/regulatory/ government regulations.

FLSA STATUS
Exempt

QUALIFICATIONS

EDUCATION

• Associate’s degree

EXPERIENCE

• Seven years of revenue cycle experience of which two years must have been in a leadership capacity

LICENSES AND CERTIFICATIONS
Required

• Must have one of the following: • RHIT - Certified Health Information Technician (AHIMA) • RHIA - Registered Health Information Administrator (AHIMA) • CCS - Certified Coding Specialist (AHIMA) • CPC – Certified Professional Coder (AAPC)

KNOWLEDGE AND ABILITIES

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
• Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
• Ability to effectively communicate through a variety of channels with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles; engages the recipient(s) and helps them understand and retain the message
• Demonstrates the ability to interact with others in a way that gives them confidence in one’s intentions and those of the organization
• Ability to use appropriate interpersonal styles and techniques to gain acceptance of ideas or plans; modifying one’s own behavior to accommodate tasks, situations and individuals involved
• Demonstrates leadership qualities and critical thinking through self-direction initiative and effective interpersonal skills and oral/written communication skills
• Ability to identify and understand issues, problems and opportunities, comparing data from different sources to draw conclusions; using effective approaches for choosing a course of action or developing appropriate solutions; taking action that is consistent with available facts, constraints and probable consequences
• Ability to work effectively in a fast paced environment
• Demonstrates flexibility and adaptability in the workplace
• Thorough understanding of managed care contracting, CPT/ICD-9/ICD-10 coding, third party and governmental payers, billing and compliance regulations, and computerized billing and collection management systems
• Project management and analytical skills

ESSENTIAL FUNCTIONS

PEOPLE ESSENTIAL FUNCTIONS

• Performs management responsibilities of selection, scheduling, supervision, retention, and evaluation of employees in the department. Provides development and mentoring of staff. Meets or exceeds threshold goal for department turnover. Develops direct reports to perform these same functions.
• Provides fair and consistent leadership and communication to maintain a competent and engaged employee group by conducting regular department meetings to review policies and procedures and operational matters, rounding on all employees, completing performance appraisals, conducting new hire feedback sessions, coaching/corrective counseling, and providing recognition/commendations to achieve desired outcomes. Provides timely guidance and feedback to help others strengthen specific knowledge/skill areas needed to accomplish a task or solve a problem.
• Facilitates and promotes effective team dynamics and teambuilding strategies within and between departments; participates and/or leads and facilitates department process improvements as needed.
• Meets or exceeds threshold goal for department and/or system metrics on employee engagement indicators.
• Responsible for coordinating audit workplan that compliments Business Practices audit workplan to reduce duplication of efforts and facilitate ongoing education and coordination with the departments to achieve successful reviews.

SERVICE ESSENTIAL FUNCTIONS

• Plans and organizes day-to-day department operations, schedule and activities. Sets priorities and functional standards, giving direction to staff as necessary to ensure the best possible delivery of service and high customer/patient satisfaction.
• Drives department service standards and activities to impact department and/or system score for patient/customer-based satisfaction, through role modeling and fostering accountability. Serves and actively participates on various entity committees as a voice for the department.
• Leads and oversees charge capture processes to include a charge capture system and regular and systematic reviews of all clinical areas to ensure accurate charge entry for all services provided.
• Serves as a leader on the ICD-10 Task Force for the PO. Responsible for managing the initiation, planning, execution, and implementation of ICD-10 and to ensure correct and compliant coding processes to maintain reimbursement from all carriers.
• Coordinates with Managed Care to complete onboarding process for new physicians and departments.
• Establishes yearly audit workplan for charge capture reconciliation team that compliments any regulations, internal audit findings or business practices findings.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

• Ensures a safe and effective working environment; monitors and/or revises the department safety plan and/or any specific accreditation/regulatory required safety guidelines, including infection control principles. Monitors and confirms staff maintain their required credentials that demonstrate competency per accrediting agency or department guidelines as applicable.
• Uses and optimizes information systems to enhance operations; supports entity-specific performance improvement and data management/analysis functions.
• Employs a proactive approach in the optimization of safe outcomes by monitoring and improving the department workflow, using peer-to-peer accountability, reporting accidents, near misses, and/or adverse events immediately per department protocol and identifying solutions via collaboration. Adopts lean principles in driving process improvements. Role models situational awareness, using teachable moments to improve safety.
• Monitors self and employee compliance with policies, procedures, and System HR Standards of Practice and performs associated actions upon non-compliance (i.e., focal point review requirements, disaster plan, in-services, influenza immunization, wage and hour, standard hours, timely termination submission, timely timecard approval, etc.).
• Develops and reports performance metrics for coding teams and ensures standards are met.

FINANCE ESSENTIAL FUNCTIONS

• Assists in the development of department budget and ensures that the department operates in a cost effective manner. Manages/audits department expenses within approved budget parameters, ensuring that the department meets the budgeted/flex revenue and/or expense targets on a monthly and annual basis. Develops staffing plans and schedules to meet department/patient needs that reflect understanding of the importance of cost-effectiveness.
• Implements department strategies to achieve financial target and staffing needs, developing others to do the same, through optimizing productivity, supply/resource efficiency, minimizing incidental overtime and overtime percentage, and other areas according to department specifications.
• Oversees and conducts analysis, identifies trends and validates compliance of fiscal activities focusing on revenue.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

• Identifies and implements innovative solutions for practice or workflow changes to improve department operations or other department-specific measures by leading unit projects and/or other department/system directed/shared governance activities. Supports change initiatives, maintaining effectiveness when experiencing major changes in work responsibilities or environment; adjusts effectively to work within new work structures, processes, requirements or cultures.
• Proactively evaluates processes; recommends and implements action plan(s) for change; follows through to ensure effective, sustainable change. Participates in the development and implementation of new procedures and the review and revision of existing procedures.
• Identifies opportunities and takes action to build strategic relationships between one’s area and other areas, teams, departments, and units to achieve business goals.
• Seeks opportunities to identify developmental needs of self and staff and takes appropriate action. Ensures own career discussions occur with appropriate management. Completes and updates My Development Plan (MDP) on an on-going basis. Conducts conversations with staff on their development.
• Researches, enhances, and maintains educational content related to ICD-10 to include introductions and awareness to ICD-10 CM systems, documentation requirements and improvement, coding and billing, and other ICD-10 related topics.

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE
• Uniform: No
• Scrubs: Yes
• Business professional: Yes
• Other (department approved): No

ON-CALL*
*Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Events, etc) regardless of selection below.
• On Call* No

TRAVEL**
**Travel specifications may vary by department**
• May require travel within the Houston Metropolitan area Yes
• May require travel outside Houston Metropolitan area No




Work Shift:

1 - Day (United States of America)



Job Category:

Non-clinical

Houston Methodist Specialty Physician Group is an integral part of Houston Methodist’s overall strategy to become one of the nation’s leading academic medical centers. Established as a nonprofit corporation certified by the Texas State Board of Medical Examiners, the Specialty Physician Group enables physicians to maintain autonomy with respect to clinical practice while growing their practice within an academic environment.


Houston Methodist is an Equal Opportunity Employer.