JOB SUMMARY:

We are seeking a detail-oriented and highly skilled Coding and Compliance Manager. This position is responsible for conducting coding audits, communicating results and recommendations to providers, management, and executive administration, and providing training and education to providers and ancillary staff. This position will support the implementation of changes to the CPT, HCPCS and ICD-10 codes on an annual basis. The ideal candidate will have a deep understanding of ICD-10-CM, CPT, HCPCS coding systems, and specialized knowledge in behavioral health services. This position requires the ability to ensure compliance with healthcare regulations and ensure proper reimbursement from insurance carriers.

Knowledge, Skills & Abilities Required:

• Coding Certification through AHIMA or AAPC for Outpatient coding. and maintains continuing education requirements.
• Must be a Certified Professional Coder (CPC)
• Excellent oral and written communication skills. Detail orientated with ability to prioritize and function independently under general supervision.
• High level critical thinking and time management skill

· · Excellent organizational skills with ability to follow written and verbal direction with multiple steps.

• Minimum 2 Years of ICD-10 and CPT coding and compliance experience and clinical knowledge in an outpatient mental health setting.
• Advanced knowledge of regulatory, billing, documentation, and other coding guidelines.
• Thorough knowledge of related prospective payment systems.
• Advanced auditing skills for coding quality and compliance.
• Advanced computer skills
• Interpersonal skills necessary to effectively communicate with other departments, physicians, outside agencies, and key customers.
• Exceptional writing skills to create reports and ability to graphically present audit data

• Conduct regular internal audits of both new and existing provider medical records to assess compliance with established standards and regulatory requirements.
• Perform assigned payer and other third party audits.
• Maintain current knowledge of coding and documentation requirements.
• Review medical records to determine appropriate ICD-10 and CPT codes are billed.
• Develop note templates based on requirements for documentation and billing.
• Provide coding and documentation training for staff regularly and as needed.
• Send queries for clinicians to assist in accurate, quality documentation within the medical record.
• Utilizes coding audit results to tailor education to increase coding accuracy.
• Leads communication and education with medical staff concerning documentation issues/queries to support accurate coding and billing.
• Supports continuous quality improvement efforts and performs special projects, training, education, and/or duties as assigned.
• Serve as a resource for training and education to clinicians, coders, billers and office staff and provides monthly refreshers to staff that need refreshers.
• Facilitate the communication and education of providers and staff regarding chart audit findings to ensure understanding and compliance.
• Maintain current, accurate, retrievable records of audit finding and education
• Provides monthly report to the leadership team, billing, and providers.
• Provides audit reports within 48 hours of each chart review outlining negative findings.
• Create and maintain coding and documentation manuals
• Seek out opportunities for learning and skill development independently.

Knowledge, Skills & Abilities Required:

• Coding Certification through AHIMA or AAPC for Outpatient coding. and maintains continuing education requirements.
• Must be a Certified Professional Coder (CPC)
• Excellent oral and written communication skills. Detail orientated with ability to prioritize and function independently under general supervision.
• High level critical thinking and time management skills

· · Excellent organizational skills with ability to follow written and verbal direction with multiple steps.

• Minimum 2 Years of ICD-10 and CPT coding and compliance experience and clinical knowledge in an outpatient mental health setting.
• Advanced knowledge of regulatory, billing, documentation, and other coding guidelines.
• Thorough knowledge of related prospective payment systems.
• Advanced auditing skills for coding quality and compliance.
• Advanced computer skills
• Interpersonal skills necessary to effectively communicate with other departments, physicians, outside agencies, and key customers.
• Exceptional writing skills to create reports and ability to graphically present audit data.