Manager Professional Billing Coding Operations - Remote
Role Overview
Responsible for the operational functions of the Professional Coding Operations team for BUMG.
Plays a strategic role in validating the accuracy of CPT, HCPCS and diagnosis code assignment by coders, physicians and non –physician practitioners.
Works closely with key revenue cycle stakeholders to understand reasons for denials, root cause analysis, and feedback to providers.
Supervises professional billing coding staff.
Partners with Coding Education Team to identify trends in coding practices and assists with developing feedback and education to providers.
Reviews coding denials to resolve and identify trends and provides feedback to providers and departments.
Performs quality assurance reviews of inpatient and outpatient records to assess and report on the effectiveness of training programs and quality of coders.
Provides in-service training and feedback to coding staff regularly, including coding changes and updates.
Oversees coding operations to ensure organizational goals are being met.
Partners with the Coding Education Team to design and implement programs on coding and clinical documentation audit and education to improve performance and efficiency.
Enforces correct application of Official Coding Rules and Regulations and follows appropriate guidelines.
Oversees the coding edits and denials and ensures compliance with payer guidelines.
The Manager, PB Coding Operations is responsible for supporting coding related, RAC, other external coding reviews, and denials related to coding.
Boston Medical Center (BMC) is more than a hospital.
It ́s a network of support and care that touches the lives of hundreds of thousands of people in need each year.
It is the largest and busiest provider of trauma and emergency services in New England.
Emphasizing community-based care, BMC is committed to providing consistently excellent and accessible health services to all—and is the largest safety-net hospital in New England.
The hospital is also the primary teaching affiliate of the nationally ranked Boston University School of Medicine (BUSM) and a founding partner of Boston HealthNet – an integrated health care delivery systems that includes many community health centers.
Join BMC today and help us achieve our Vision 2030 which is a long-term goal to make Boston the healthiest urban population in the world.
Position: Manager Professional Billing Coding Operations – Remote
Full Job Posting
JOB REQUIREMENTS
- EDUCATION:
- Bachelor’s degree or equivalent combination of formal education and experience.
- CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:
- CPC – Certified Professional Coder
- Must have at least five years of experience in coding; experience must include education/mentoring/training.
- Prior experience working claim edits and denials.
- Excellent command of the ICD-10-CM and CPT4/HCPCS coding conventions, E&M coding. Work also requires concepts of human anatomy, physiology and pathology.
- Excellent skill in providing hands-on education to PB Coding Operations staff based on audit finding and need.
- Strong knowledge of health records, computerized billing and charging systems, Microsoft applications, data integrity, and processing techniques required.
- Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.
- Ability to work with accuracy and attention to detail
- Ability to solve problems appropriately using job knowledge and current policies/procedures.
- Ability to work cooperatively with members of the healthcare delivery team and staff, ability to handle frequent interruptions and adapt to changes in workload and work schedule and to respond quickly to urgent requests.
- Must be able to maintain strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations.
- Must possess extensive knowledge of hospital inpatient and outpatient reimbursement methodologies.
- Strong knowledge of health records, computer systems, Microsoft applications, data integrity, and processing techniques required.
- Ability to mentor, guide and motivate direct reports through demonstration of best practices and leading by example.
- Ability to maintain and enforce strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations.
- Must possess extensive knowledge of payer claim edits and payer denials. Work requires in-depth knowledge of medical terminology, ICD-10-CM and CPT-4 Coding conventions (including E&M coding), CMS National Coverage Determinations and various other applicable coding regulations and law.
- $78,000.00- $113,000.00
- This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), discretionary annual bonuses and merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family well-being.
- NOTE: This range is based on Boston-area data, and is subject to modification based on geographic location.
- Equal Opportunity Employer/Disabled/Veterans
- According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website and applications are received only through our website. We do not ask or require downloads of any applications, or “apps” job offers are not extended over text messages or social media platforms. We do not ask individuals to purchase equipment for or prior to employment.
EXPERIENCE:
- Minimum of five years acute care hospital experience coding with ICD-10-CM and CPT-4, academic medical setting or trauma center preferred.
- Minimum of three years management experience required; five years preferred.
KNOWLEDGE AND SKILLS:
- Excellent command of the ICD-10-CM and CPT4/HCPCS coding conventions, E&M coding. Work also requires concepts of human anatomy, physiology and pathology.
- Excellent skill in providing hands-on education to PB Coding Operations staff based on audit finding and need.
- Strong knowledge of health records, computerized billing and charging systems, Microsoft applications, data integrity, and processing techniques required.
- Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.
- Ability to work with accuracy and attention to detail
- Ability to solve problems appropriately using job knowledge and current policies/procedures.
- Ability to work cooperatively with members of the healthcare delivery team and staff, ability to handle frequent interruptions and adapt to changes in workload and work schedule and to respond quickly to urgent requests.
- Must be able to maintain strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations.
- Must possess extensive knowledge of hospital inpatient and outpatient reimbursement methodologies.
- Strong knowledge of health records, computer systems, Microsoft applications, data integrity, and processing techniques required.
- Ability to mentor, guide and motivate direct reports through demonstration of best practices and leading by example.
- Ability to maintain and enforce strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations.
- Must possess extensive knowledge of payer claim edits and payer denials. Work requires in-depth knowledge of medical terminology, ICD-10-CM and CPT-4 Coding conventions (including E&M coding), CMS National Coverage Determinations and various other applicable coding regulations and law.
- Compensation Range:
- $78,000.00- $113,000.00
- This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), discretionary annual bonuses and merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family well-being.
- NOTE: This range is based on Boston-area data, and is subject to modification based on geographic location.
- Equal Opportunity Employer/Disabled/Veterans
- According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website and applications are received only through our website. We do not ask or require downloads of any applications, or “apps” job offers are not extended over text messages or social media platforms. We do not ask individuals to purchase equipment for or prior to employment.
Preferred Qualifications
- Minimum of five years acute care hospital experience coding with ICD-10-CM and CPT-4, academic medical setting or trauma center preferred.
- Minimum of three years management experience required; five years preferred.
About Boston Medical Center
Academic medical center providing comprehensive healthcare and medical education.
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