Director Medical Group Coding - CPC Required

Job Summary:

Plans, directs, organizes, controls, and oversees all daily functioning of the Virtua Medical Group Coding Department. Duties include ensuring ethical, accurate, and compliant coding for VMG, keeping unbilled accounts under acceptable levels to support A/R, development of compliance and education programs, and oversight and engagement of staff. Responsible for workflow design, as well as formulation of and adherence to policies and procedures. Identifies process opportunities to enhance coding and reimbursement. Serves as a liaison to the Virtua Medical Group clinicians, practice operations team, billing staff, and administration.

Position Responsibilities:

Plans and directs daily functions of the VMG Coding Department. Ensures compliance with federal, state, and payer requirements. Ensures ethical and accurate coding, as well as review of provider assigned codes. Responsible to maintain A/R at an acceptable level and determine remediation plans for backlogs or workload increases.

Develops and maintains quality, productivity, and workflow standards within VMG’s coding department. Identifies opportunities for enhancement of coding processes and develops workflow to support improvements. Ensures appropriate use of technology to support best practices.

Human resource management: Interviews, hires, trains, coaches, counsels, disciplines, terminates, evaluates coding managers. Mentors coding managers, focusing on improving their leadership, communication, decision-making, and problem-solving skills. Recognizes managers and staff. Performs payroll and associated functions.

Develops and implements training plans for providers and coding staff and ensures proficiency. Provides clear instruction and ensures staff accountability and adherence to established standards.

Develops compliance and audit plans and is responsible for implementing these plans, using a mixture of internal and external audits. Plans and directs the annual external audit process to ensure all clinicians who bill under the VMG tax ID number (TIN) are audited and receive coding education annually. Ensures ongoing audits of provider coding and establishes appropriate feedback mechanisms for providers, resulting in continuous quality improvement.

Monitors coding-related denials and actively determines causal trends. Translates those trends into operational changes for coding department as needed. Ensures best practice to proactively work through denial trends.

Establishes and maintains productive relationships and communication with all providers and clinicians, as well as practice management and billing department. Offers suggestions for recommendations for resolution of problems and open issues. Collaborates with external colleagues to learn best practice and ensure Virtua is at the forefront for coding practice.

Develops and operates within budgetary guidelines and is able to justify and explain variances. Thoroughly reviews financial statements and identifies ways to decrease cost and maximize performance. Recommends new revenue sources as appropriate.

Position Qualifications Required:

Required Experience:

Expert knowledge of professional fee coding required (ICD-10, CPT, HCPCS, and other reimbursement methodologies), including compliance and audit requirements.

5 years of supervisory experience preferred. 7+ years of coding experience required.

Excellent organizational, communication, and customer service skills.

Ability to utilize Information Systems, including electronic health records, effectively.

Ability to make sound decisions independently and provide guidance.

Required Education:

High School Degree required. Associate's or Bachelor’s degree in applicable field preferred.

Training / Certification / Licensure:

Certification as a CPC required. CCS-P considered.

RHIA/RHIT certification or eligibility a plus.