Revenue Cycle Supervisor (bh Billing)

Definition

Definition: Under general supervision this position directs and coordinates the daily activities of the medical coders and maintains a good working relationship with all the operational leaders to ensure accurate patient/ insurance billing and efficient account collection; create process improvement plans, define and monitor key performance metrics, analyze and interpret data and manage change and facilitate improvements. This job class is treated as FLSA Exempt

Essential Functions: Essential functions may vary among positions and may include the following tasks, knowledge, skills, abilities and other characteristics. This list of tasks is ILLUSTRATIVE ONLY and is not intended to be a comprehensive listing of tasks performed by all positions in this classification.

Examples of Tasks

Coding

• In partnership with Revenue Cycle Manager, oversee coding function; reporting issues as they occur, and ensuring collection points and denials codes are updated.
• Train and mentor new hires, and follow up with staff to ensure they are assigned work daily, weekly, and monthly. Follow up with Medical Coder II's to ensure all departmental procedures and guidelines are followed.
• Stay informed about coding rules, federal and state regulations and insurance contracts including, but not limited to, the following:
• International Classification of Disease (ICD-10) codes
• Current Procedural Terminology (CPT) & Healthcare Common Procedure Coding System (HCPCS) codes and procedures
• Diagnostic and Statistical Manual of Mental Disorders (DSM-5) codes
• ICPM (International Classification of Procedures in Medicine)
• Certification of Disability Management Specialist (CDMS) coding and reporting knowledge.
• Communicate clearly with physicians, patients and other healthcare professionals to clarify diagnosis and billing codes.
• Coordinate with the Billing Supervisor to identify codes that document services and procedures performed that pertain to billable services.
• Coordinate with the Billing Supervisor & Billing Specialists to identify codes that document services and procedures performed that pertain to billable services and assists with transmitting data to the Billing Specialist and reviews the correct data entry errors detected after transmission as required.
• Assist in overseeing the daily operations of multi-specialty coding for Clinic Providers and Behavioral Health counselors coders in the provision of coding as it pertains to All-Inclusive (AIR) Federally Qualified Health Care and physician services.
• Provide education and training to physicians and non-physician providers on the assignment of CPT, HCPCS and ICD-10 codes, as well as, documentation and coding guidelines.
• Train new hires, mentors all staff, follow up with Coder level two's to ensure all departmental procedure and guidelines are adhered to per organization policies and procedures
• Complete staff EPAR's on time including meeting with the employee.
• Works with other departments to problem solve missing charges, coding errors, codes for new services, missing documentation such as chart reviews and deficiencies.
• Provide accurate coding guidelines to all providers to ensure their charting and coding is appropriate per Medicare and AHCCCS guidelines.
• Accurately interprets medical records including diagnosis and procedures performed by behavioral and medical healthcare providers.
• Abide by the Standards of Ethical Coding as set forth by the American Health Information management Association, and reports areas of concerns to the Revenue Cycle Manager.
• Ensure coders are completing weekly productivity and records their numbers on the Master Productivity Log. Report monthly productivity to the Revenue Cycle Manager.
• Review provider chart notes and conduct monthly audits per provider and report it to the Medical Director and Revenue Cycle Manager
• Stay informed about new technology in coding and abstracting software and other forms of automation.
• Direct, monitor, and evaluate subordinate staff. Identify developmental needs and assists in the composition of plans for further education and development of team members.
• Demonstrate and maintain competency in the use of computer applications, particularly the coding and abstracting software and hardware currently in use.
• Prepare and maintain a variety of complex records and reports for Coding as well as for staff as needed.
• Report major coding error trends to the Revenue Cycle Manager. Compose corrective plan to address major coding error trends for both Medical and BHS providers.
• Ensure coding team workload is distributed appropriately.
• Ensure safekeeping and confidentiality of all record as required by Community or applicable law.

Information Management

• Ensure the safekeeping and confidentiality of all records as required by Community or applicable law.
• Review coding queue reports for behavioral health and all other clinical services, troubleshoot practice management system, and perform file transfers as needed (VMWare).
• Knowledge and experience with an electronic health records and/or RPMS.

Miscellaneous: Perform other job-related duties as assigned by the HHS Revenue Cycle Manager

Knowledge, Skills, Abilities, and Other Characteristics:

• Knowledge of the history, customs, culture, traditions and government of the Salt River Pima- Maricopa Indian Community
• Knowledge and working familiarity with electronic health records and/or RPMS.
• Knowledge of various insurance plans and limitations of various plans including the Arizona HealthCare Cost Containment System (AHCCCS) and Medicare.
• Knowledge of insurance terminology including standard abbreviations used in the healthcare industry.
• Knowledge of accurate and descriptive CPT/HCPCS codes for national coding determination per Medicare using the proper ICD-10 codes and other coding resources to ensure proper payment of claims in a timely manner.
• Knowledge of CMS and AHCCCS coding and reporting.
• Knowledge of Federal Qualified Healthcare coding and HIPAA laws as they pertain to the SRPMIC work environment.
• Knowledge of working with Practice Management systems, and other software such as Resource Practice Management Systems (RPMS) patient registration, pharmacy, dental, pediatrics, laboratory, behavioral services, and other specialties as assigned.
• Ability to use Practice Management Systems while being computer literate by entering and maintaining patient information within the database.
• Skill to strategically decipher the correct medical codes and use terminology to code accurately
• Skill correlating generalized medical observations and systems (vital signs, lab results, medications, etc.,) to stated diagnosis in order to assign the proper billing code(s).
• Skill in the use of practice management software application, calculator, copy machine and other essential office equipment,
• Skill with verbal and written communication and the ability to communicate effectively with a wide range of people, clients, families, community groups and health professionals,
• Ability to manage various employee types in stressful situations,
• Ability to establish and maintain positive and effective working relationships with colleagues, subordinates, supervisors, health care professionals, Tribal officials, representatives or resource agencies, patients and Community members,
• Ability to work as a productive member of a team and deal with sensitive issues and maintain appropriate, professional and confidential relationships,
• Ability to incorporate cultural differences, health beliefs and learning styles,
• Ability to develop and implement program protocols as well as identify and address programmatic problems.
• Demonstrates proficiency with information management.

Minimum Qualifications

Education: Associates Degree required. Bachelor degree preferred.

• Must have at time of hire AAPC or AHIMA certifications
• CCS-P or RHIA certification is preferred
• Hands-on experience assigning, validating, and abstracting CPT/ICD 10 Coding Experience
• Ability to code per Medicare and AHCCCS guidelines.
• Knowledge of working and coding for a Federally Qualified Health Center (FQHC)

Experience:

• 3-5 years' experience professional coding experience required.
• Three (3) years' experience as lead or supervisory responsibilities required.
• Prior experience as a revenue cycle / billing supervisor preferred.
• Federally Qualified Healthcare Center (FQHC) coding experience preferred.
• Multi-specialty group coding experience preferred.
• Experience working with Native Americans strongly preferred.
• Proficient in Microsoft Excel.

Equivalency:Any equivalent combination of education and/or experience that would allow the candidate to satisfactorily perform the duties of this position, will be considered.

Underfill Eligibility:An enrolled Community Member whom closely qualifies for the minimum qualifications for a position may be considered for employment under SRPMIC Policy 2-19, Underfill.

Special Requirements

May be required to work beyond normal work hours including nights, weekends and holidays.

Prior to hire as an employee, applicants will be subject to drug and alcohol testing. Will be required to pass a pre-employment background/fingerprint check.

"SRPMIC is an Equal Opportunity/Affirmative Action Employer" Preference will be given to a qualified : Community Member Veteran, Community Member, Spouse of Community Member, qualified Native American, and then other qualified candidate.

In order to obtain preference, the following is required:1) Qualified Community Member Veteran (DD-214) will be required at the time of application submission 2) Qualified Community Member (must provide Tribal I.D at time of application submission),3) Spouse of a Community Member (Marriage License/certificate and spouse Tribal ID or CIB is required at time of application submission), and 4) Native American (Tribal ID or CIB required at time of application submission).

Documents may be submitted by one of the following methods:

1) attach to application

2) fax (480) 362-5860

3) mail or hand deliver to Human Resources.

Documentation must be received by position closing date.

The IHS/BIA Form-4432 is not accepted .

Your Tribal ID/CIB must be submitted to HR-Recruitment-Two Waters.

Benefits:

The SRPMIC offers a comprehensive benefit package including medical, dental, vision, life, disability insurance, and a 401(k) retirement plan. In addition employees enjoy vacation and sick leave and 13 paid holidays.