Mgr - Coding Education and Quality

The Manager over Coding Education and Quality is responsible and accountable for initial and ongoing education and audit of providers, Carle coding team members, and external coders to assure a high level of coding quality and accuracy for Carle. The manager organizes and coordinates the coding audit teams to achieve goals and reviews and implements policies to assure compliance with recommended coding quality levels. As part of the Health Information Management team, the Manager over Coding Education and Quality collaborates with coding managers and clinical documentation integrity manager to ensure excellence in hospital and ambulatory coding.

The manager coordinates external audits and oversees all internal coding auditing, including audits for the global coding team. The manager is responsible for establishing and maintaining a framework of conducting regular coding audits for all coders and providers, to include providing individual feedback, providing regular educations sessions, and providing coding guidance through regular review of literature, rules, regulations and coding policies, both internal and external.

The coding manager oversees the activities and onboarding of the global coding teams and assures the professional fee audits are completed per compliance policies. This position is also responsible for tracking coding trends and assists with mitigation of coding-based denials through education of coding team members. The role will update providers on coding regulatory changes and will maintain the education on the coding True North Page as well as collaborate with physicians on education sessions either individual or group settings.

Certifications:

• Certified Coding Specialist (CCS) or
• Certified Professional Coder, Hospital (CPCH) or
• Registered Health Information Technician (RHIT) or
• Registered Health Information Administrator (RHIA)

Education:

• Bachelor's Degree - Allied Health, Education, or Health Information Management

Work Experience:

• Coding - 5 years
• Reporting - 1 year
• Ability to analyze data and create actions plans - 1 year
• Ability to lead and direct teams - 1 year
• Working knowledge in billing and EMS systems - 1 year

Specialized Knowledge and Skills Requirements

• Excellent reading, writing and communication skills.
• Excellent knowledge of ICD10, CPT, modifier and E/M coding and coding concepts.
• Ability to use Microsoft 360 software including outlook, word, PowerPoint and excel.
• Ability to develop and present graphs and power point presentations.
• Ability to present complex concepts to teams or individuals.
• Epic system experience preferred.

• Lead coding quality and education teams of hospital, professional fee and global coding auditors
• Evaluate and revise policies and procedures as needed to ensure quality coding
• Develop and provide education to internal coders and providers as needed.
• Develop and update coding department newsletters, education and reference documents.
• Post to True North page as needed.

• Ensure team members are educated on coding concepts and coding software
• Review, evaluate and educate coding team members and providers on updated rules and regulations related to coding, include new LCDs/NCDs/Medicare guidelines/AMA guidelines
• Ensure completion of provider audits to meet compliance policies and timelines
• Collaborate with coding and CDI operation managers on coding topics and guidelines
• Provide regular audits and education to Carle coding team members on relevant coding topics

• Track, trend and advise on outcomes of coding audits and needs for coder or provider specific education.
• Submit reports and monitor monthly audits are completed timely.
• Share information with leadership and providers.
• Research denial trends related to coding
• Provide necessary education to mitigate denials to coding team based on review

• Collaborate with leaders on education related to coding for providers and identify opportunities for improvement
• Provide guidance and counsel to providers face to face and or virtually.
• Identifies educational/learning needs, planning, evaluating and implementing educational programs
• enhance documentation and coding practices across the organization.
• Attends meetings specific to coding topics as needed and requested.

• Serve as liaison between the providers, clinical staff and coders.
• Serves a point of contact for clinical coding inquiries.
• Demonstrate the attention to detail to minimize coding errors
• Legitimately optimize reimbursement and ensure accurate billing.
• Analyzes billing trends and claim denial reports to ensure optimal reimbursement.

• Ensure global coding team members are meeting established quality standards
• Works closely with global vendors to analyze coder competency
• Ensure quality standards are being met.
• Escalates recommendations to HIM leadership based on review results.
• Department Specific Job Function
• Read and revise HIM policies specific to coding and auditing for Carle
• Attend management training for HIM leaders
• Use specific coding software, including solventum and encoder pro
  

Find it here.

Discover the job, the career, the purpose you were meant for. The supportive and inclusive team where you can thrive. The place where growth meets balance - and opportunities meet flexibility. Find it all at Carle Health.

Based in Urbana, IL, Carle Health is a healthcare system with nearly 16,600 team members in its eight hospitals, physician groups and a variety of healthcare businesses. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet designations, the nation's highest honor for nursing care. The system includes Methodist College and Carle Illinois College of Medicine, the world's first engineering-based medical school, and Health Alliance. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com.