Manager - Coding/Reimbursement - Revenue Cycle

13265 Enterprise Revenue Cycle - PFS: Medical Necessity

Full time

Yes

40

Varies

Pay Range

$37.50 - $56.25

Job Summary

Monitors and oversees the day to day operations within the department. Accountable for the charge capture and claim resolution portion of the revenue cycle. The Manager must have thorough knowledge of ICD, CPT, and HCPCS coding principles.

Essential Functions

• Coaches and develops of supervisory team members.
• Works with leadership team to address provider needs and ensures communication is helpful, effective, and consistent.
• Ensures adherence to all departmental policies.
• Develops, implements, and monitors quality assurance reviews.
• Assesses, implements, and continuously monitors workflow and volumes to ensure workload is balanced among team members.
• Assesses and reacts to workflow changes related to departmental growth.
• Ensures effective communication with both internal and external customers.
• Develops, implements, and monitors a comprehensive training program to include career ladder development. Addresses departmental training needs based on team member performance and quality reviews.
• Conducts quality assurance reviews as needed. Provides education as a result of these reviews.
• Stays abreast and communicates coding changes (i.e. new codes, new technology, payor requirements).
• Monitors key performance indicators (KPIs) to include, but not limited to, denials, AR Trends, edit volumes, and charge lag.
• Participates in strategic planning and design in coding, regulatory, and system changes that impact coding, reimbursement, and compliance.
• Oversight of medical necessity work queues to address CCI, LCD, NCD, MUE, etc. edits prior to claims submission.
• Reviews denials for medical necessity to facilitate department review as needed, add modifiers, and make adjustments per payer policy

Physical Requirements

Works in a fast-paced office/hospital environment. Work consistently requires sitting and some walking, standing, stretching, and bending. Some travel may be required.

Education, Experience and Certifications

Bachelor's degree or 8 years related experience required. 1-3 years supervisory experience preferred. CPC or coding credential required. Demonstrates professional presence and effective presentation skills.

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program