As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions?Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
Conifer Compliance maintains and oversees a compliance program that is consistent with the HHS Office of Inspector Generalï¿½s Compliance Program Guidance for Third Party Medical Billing Companies (ï¿½Guidanceï¿½), which is built around the seven fundamental elements described in the Guidance.In addition, Coniferï¿½s Compliance program is consistent with the Department of Justice Complaince Program Guidelines.
The Coding Compliance Manager is responsible for overseeing risk-based reviews to ensure they are performed accurately and timely according to Conifer Coding Compliance policies and work plan. In addition, the Coding Compliance Manager will serve as a subject-matter expert for coding-related compliance investigations.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Responsible for organizing and maintaining coding compliance reviews in accordance with Conifer policies and procedures, including managing a team of auditors to ensure all appropriate facilities are included in the audit procedure and to ensureappropriate risk-based areas of coding are identified and included in audit samples.
Ensures review findings are clear and accurate; responsible for reporting audit trends as an opportunity for coder/auditor education, training, and corrective actions.Uses findings to advise on policies, processes, and training for overall improvement in coding and auditing quality and related functions.
Serves as resource for other coding compliance team members and leaders.Responsible for all training, mentoring, and performance managing new and existing staff.
Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM, CPT, MS-DRGs, APR-DRGs, APCs, and RVUs. Completes online education courses and attends mandatory coding workshops and/or seminars (MPFS, IPPS and OPPS, ICD-10 and CPT updates) for all coding types..Reviews AHA and CPT quarterly coding update publications. Attends all internal conference calls for Quarterly Coding Updates.
Creates coding compliance reports and engagement letters; ensures audits are tracked in software system; researches complex issues through to resolution; serves as a subject-matter expert; and develops and presents educational sessions to remediate audit findings.Performs audits as needed.
Advises the Complaince Leadership Teamin the development of the Annual Compliance Work Plan and Auditing Plan.
Provides input regarding departmental budget specific to area of responsibility.
Reviews and approves expense reports for direct reports.
KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Thorough knowledge of Official Coding Guidelines, Federal and State coding regulations, payor specific coding rules, and third party billing requirements and ability to compare/contrast the guidelines/rules/regulations in order to discern which apply to the audit being performed
Adheres to AHIMAï¿½s Standards of Ethical Coding in addition to Coniferï¿½s Ethics Standards
Consistently exercises discretion and independent judgment when performing and documenting audit results
Strong leadership and communication skills, problem solving abilities; good knowledge of medical records systems
Expert level knowledge of medical terminology, anatomy, disease pathophysiology and drug utilization
Expert level knowledge of MS-DRG ,APR-DRG, APC, OCE, NCCI, and RVU classification and reimbursement structures
Expert level knowledge of medical terminology, ICD-10-CM/PCS and CPT coding guidelines and methodologies
Expert level knowledge of HACs, PSIs, and HCCs
Keeps abreast of new technology in coding and abstracting software and other forms of automation and stays informed about transaction code sets, HIPAA requirements and other future issues impacting the coding function
Must display excellent interpersonal skills
Ability to manage time effectively and prioritize assignments and projects
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
Five (5) years of previous relevant management experience related to coding compliance functions.
Documented experience in coding compliance and/or coding quality including, but not limited to, hospital inpatient,outpatient, and ambulatory surgery center
Experience with ICD-10-CM/PCS, CPT, HCPCS, and CDI
Bachelor/Associate degree and AHIMA coding credential
Include minimum certification required to perform the job.
AHIMA coding credential, CCS preferred
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Must be able to work in sitting position, use computer and answer telephone
Ability to travel
Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Telecommuting Office Work Environment
Hospital Work Environment
Approximately 25% travel may be required
Job: Conifer Health Solutions
Primary Location: Frisco, Texas
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Internal Number: 2005030773
About Conifer Health Solutions
Tenet Healthcare Corporation is a diversified healthcare services company with 115,000 employees united around a common mission: to help people live happier, healthier lives. Through its subsidiaries, partnerships and joint ventures, including United Surgical Partners International, the Company operates general acute care and specialty hospitals, ambulatory surgery centers, urgent care centers and other outpatient facilities. Tenet's Conifer Health Solutions subsidiary provides technology-enabled performance improvement and health management solutions to hospitals, health systems, integrated delivery networks, physician groups, self-insured organizations and health plans.