Director of Provider Coding and Billing - TMG (Days)
Apply NowCompany: Tanner Medical Center
Location: Carrollton, GA 30117
Description:
Job Description
JOB STANDARD
TITLE: Director of Provider Coding and Billing, TMG
STATEMENT OF EMPLOYMENT PHILOSOPHY: As a member of Tanner Medical Center, you are a part of a quality driven organization which is devoted to customer service and dedicated to the continuing education of its staff. In our environment of delivering health care, employees will show respect for others, demonstrate honesty and integrity, maintain the patients' right to confidentiality, possess a positive and courteous attitude and take the initiative to go above and beyond what is expected in a teamwork environment.
REPORTS TO AND EVALUATED BY: The position reports to the Vice President of Finance and Analytics, TMG. Each year this position will receive an annual evaluation. The evaluation process will be performed by the VP of Finance and Analytics, TMG. The evaluation also may include involvement of Tanner team member employees and physicians, as appropriately determined, who have had the opportunity to work with the TMG's Director of Provider Coding and Billing. This input will also serve to assist the VP of Finance and Analytics in valuing the position's benefits to Tanner Health System and the TMG.
HOURS: Salaried, 8 hours per day - 5 days per week. Occasional evening / weekend work may be required.
PHYSICAL DEMANDS: Most of the work will be done while sitting. Close visual contact with CRT screens. Work will include close visual effort and concentration. Speaking and hearing required for conversing with employee co-workers and physicians. Visual acuity required for reading patient account documentation, medical record documentation and reports. Mental acuity required making independent decisions and process of information. Lifting from 10-20 pounds may be necessary.
WORKING CONDITIONS: Normal office environment. May involve a combination of remote and on-site work. Occasional travel to different practice locations as required.
RESPONSIBILITIES:
This position will review and audit provider documentation and coding practices to identify areas for improvement. This includes providing feedback to providers on coding errors and offer recommendations for improvement.
This position conducts regular audits of billing and coding processes to identify and address any discrepancies or areas of improvement.
This position will serve as a subject matter expert on coding and documentation for healthcare providers and staff, providing guidance and support on complex coding issues, including the correct use of modifiers, evaluation and management (E/M) coding, and diagnosis coding.
This position will work with providers to improve the quality and completeness of clinical documentation to ensure accurate code assignment and optimal reimbursement. Including promoting best practices in documentation that support accurate coding and billing.
This position will lead and manage the billing and coding team, including hiring, training, evaluating, and mentoring staff.
This position will develop and implement policies and procedures to ensure efficient and compliant billing and coding practices.
This position will conduct regular team meetings and provide ongoing education on coding updates and changes in regulations. This includes delivering coding education to healthcare providers, focusing on accurate coding, documentation improvement, and compliance. Conduct one-on-one training sessions, group workshops, and webinars as needed.
This position will customize training materials to address the specific needs of different departments and specialties.
This position will oversee the entire billing process, from patient registration to account resolution.
This position will ensure timely and accurate submission of claims to insurance companies and other payers.
This position will monitor and manage accounts receivable, reducing days in accounts receivable and improving collection rates.
This position will collaborate with coding teams to analyze audit results and develop targeted education plans.
This position will ensure compliance with federal, state and local regulations, including HIPAA, CMS guidelines, and payer-specific requirements, including Medicare, Medicaid and other third-party payer requirements.
This position will implement and monitor quality assurance programs to ensure accuracy and efficiency in coding and billing practices. Including reporting on coding accuracy and documentation quality, identifying trends and areas for improvement.
This position will collaborate with the finance team to develop strategies for optimizing reimbursement and reducing denials.
This position will stay updated on industry trends and technological advancements to enhance department efficiency and accuracy.
This position will work with IT to resolve any system-related issues that affect the billing and coding process.
This position will track and report on the effectiveness of coding education programs, including improvements in coding accuracy and documentation quality.
This position will use data to identify areas where additional education or support may be needed.
This position will provide regular reports to leadership on coding education initiatives and outcomes.
This position will collaborate with other departments, such as clinical, IT and finance, to ensure cohesive operations and address any billing and coding-related issues.
This position will serve as the primary point of contact for external auditors, insurance companies, and regulatory agencies regarding billing and coding matters.
Contact with Others: Position will require contact with individuals within the department, employees within each physician practice, physicians and other hospital employees and external parties as necessary.
Effect of Error: Errors could be serious and involve loss of revenue. The absence of errors will ensure that the credibility of the Physician Management Team is maintained. Work will require the ability to prioritize and plan. Employee will work regularly with sensitive and confidential data. Work will involve detailed coding and financial knowledge. The work entails a knowledge of the health care business.
COMPLIANT STATEMENT
Employee performs within the prescribed limits of Tanner Health System's Ethics and Compliance program. Employee is responsible to detect, observe and report compliance variances to their immediate supervisor, the Compliance Officer or to the Employee Hotline for this purpose.
MENTAL DEMANDS
SUPERVISION: Exercises direct supervision of other employees.
QUALIFICATIONS REQUIRED:
Education: Bachelor degree required in Health Information Management, Business Administration or related field. Certification in Medical Coding (CPC, CCS) and Billing (CPB) required. In-depth knowledge of medical billing, coding systems, (ICD-10, CPT, HCPCS), and healthcare reimbursement methodologies. Strong understanding of federal and state healthcare regulations, including HIPPA and CMS guidelines. Proficiency in healthcare billing software and electronic health records (EHR) systems. Minimum of 5-7 years experience in medical billing and coding, with at least 3 years in a supervisory or managerial role. Excellent leadership, communication, and organizational skills. Ability to analyze financial data and generate reports. Strong problem-solving skills and attention to detail.
Signed: Date:
JOB STANDARD
TITLE: Director of Provider Coding and Billing, TMG
STATEMENT OF EMPLOYMENT PHILOSOPHY: As a member of Tanner Medical Center, you are a part of a quality driven organization which is devoted to customer service and dedicated to the continuing education of its staff. In our environment of delivering health care, employees will show respect for others, demonstrate honesty and integrity, maintain the patients' right to confidentiality, possess a positive and courteous attitude and take the initiative to go above and beyond what is expected in a teamwork environment.
REPORTS TO AND EVALUATED BY: The position reports to the Vice President of Finance and Analytics, TMG. Each year this position will receive an annual evaluation. The evaluation process will be performed by the VP of Finance and Analytics, TMG. The evaluation also may include involvement of Tanner team member employees and physicians, as appropriately determined, who have had the opportunity to work with the TMG's Director of Provider Coding and Billing. This input will also serve to assist the VP of Finance and Analytics in valuing the position's benefits to Tanner Health System and the TMG.
HOURS: Salaried, 8 hours per day - 5 days per week. Occasional evening / weekend work may be required.
PHYSICAL DEMANDS: Most of the work will be done while sitting. Close visual contact with CRT screens. Work will include close visual effort and concentration. Speaking and hearing required for conversing with employee co-workers and physicians. Visual acuity required for reading patient account documentation, medical record documentation and reports. Mental acuity required making independent decisions and process of information. Lifting from 10-20 pounds may be necessary.
WORKING CONDITIONS: Normal office environment. May involve a combination of remote and on-site work. Occasional travel to different practice locations as required.
RESPONSIBILITIES:
This position will review and audit provider documentation and coding practices to identify areas for improvement. This includes providing feedback to providers on coding errors and offer recommendations for improvement.
This position conducts regular audits of billing and coding processes to identify and address any discrepancies or areas of improvement.
This position will serve as a subject matter expert on coding and documentation for healthcare providers and staff, providing guidance and support on complex coding issues, including the correct use of modifiers, evaluation and management (E/M) coding, and diagnosis coding.
This position will work with providers to improve the quality and completeness of clinical documentation to ensure accurate code assignment and optimal reimbursement. Including promoting best practices in documentation that support accurate coding and billing.
This position will lead and manage the billing and coding team, including hiring, training, evaluating, and mentoring staff.
This position will develop and implement policies and procedures to ensure efficient and compliant billing and coding practices.
This position will conduct regular team meetings and provide ongoing education on coding updates and changes in regulations. This includes delivering coding education to healthcare providers, focusing on accurate coding, documentation improvement, and compliance. Conduct one-on-one training sessions, group workshops, and webinars as needed.
This position will customize training materials to address the specific needs of different departments and specialties.
This position will oversee the entire billing process, from patient registration to account resolution.
This position will ensure timely and accurate submission of claims to insurance companies and other payers.
This position will monitor and manage accounts receivable, reducing days in accounts receivable and improving collection rates.
This position will collaborate with coding teams to analyze audit results and develop targeted education plans.
This position will ensure compliance with federal, state and local regulations, including HIPAA, CMS guidelines, and payer-specific requirements, including Medicare, Medicaid and other third-party payer requirements.
This position will implement and monitor quality assurance programs to ensure accuracy and efficiency in coding and billing practices. Including reporting on coding accuracy and documentation quality, identifying trends and areas for improvement.
This position will collaborate with the finance team to develop strategies for optimizing reimbursement and reducing denials.
This position will stay updated on industry trends and technological advancements to enhance department efficiency and accuracy.
This position will work with IT to resolve any system-related issues that affect the billing and coding process.
This position will track and report on the effectiveness of coding education programs, including improvements in coding accuracy and documentation quality.
This position will use data to identify areas where additional education or support may be needed.
This position will provide regular reports to leadership on coding education initiatives and outcomes.
This position will collaborate with other departments, such as clinical, IT and finance, to ensure cohesive operations and address any billing and coding-related issues.
This position will serve as the primary point of contact for external auditors, insurance companies, and regulatory agencies regarding billing and coding matters.
Contact with Others: Position will require contact with individuals within the department, employees within each physician practice, physicians and other hospital employees and external parties as necessary.
Effect of Error: Errors could be serious and involve loss of revenue. The absence of errors will ensure that the credibility of the Physician Management Team is maintained. Work will require the ability to prioritize and plan. Employee will work regularly with sensitive and confidential data. Work will involve detailed coding and financial knowledge. The work entails a knowledge of the health care business.
COMPLIANT STATEMENT
Employee performs within the prescribed limits of Tanner Health System's Ethics and Compliance program. Employee is responsible to detect, observe and report compliance variances to their immediate supervisor, the Compliance Officer or to the Employee Hotline for this purpose.
MENTAL DEMANDS
SUPERVISION: Exercises direct supervision of other employees.
QUALIFICATIONS REQUIRED:
Signed: Date: