Manager, Coding Compliance (Hybrid) - Pediatrics

Scheduled Hours 40 Position Summary The Department of Pediatrics is seeking a progressive and skilled Manager of Coding and Compliance. The Manager will oversee the billing cycle and coding function of a large, complex department of 15 clinical division with both inpatient and outpatient coding and coding review involved. Demonstrated excellence in the areas of ensuring coders are coding with accuracy, aligned with regulatory compliance rules, and supporting timeline reimbursement is required. This role serves as the subject matter expert for coding guidelines and must stay current about CMS changes and payor policies as well as any healthcare regulations that may impact coding, billing, and reimbursement. The Manager oversees day-to-day operations of charge capture activities assuring compliance and maximizing revenue and should have deep clinical experience, preferably as a nurse or other clinical staff member. They will manage the coding team that reviews and analyzes clinical documentation and medical records. The Manager should have working knowledge of clinical workflows and the Epic EMR. This leader is responsible for overseeing a team reviewing complex clinical documentation and diagnostic results timely to accurately assign codes for diagnoses (ICD-10), procedures (CPT), and applicable modifiers for services provided to assure maximum reimbursement and regulatory compliance. This leader will also assist in the audit of medical records in order to identify potential problems with the coding and reimbursement process such as edits, denials, appeal letters, and other resolution mechanisms designed to obtain maximum reimbursement in a compliant way. Job Description Primary Duties & Responsibilities: Supervise Coding Coordinators to assure hospital based services captured timely and to maximize revenue. Directly interact and communicate with faculty on coding, charge capture, compliance and other billing related issues. Perform compliance related duties such as review of medical documentation, completion of physician audits and OPBC audits. Develop educational material and conducts regular meetings with faculty to determine methods of improving coding and documentation. Assure staff attends scheduled training/in-services. Keeps abreast of procedures and changes affecting Medicare, Medicaid, HMO, PPO and related health care operations. Communicate policies and procedures to staff on billing issues to promote efficient flow of billing process and maximum reimbursement, aligned with compliance. Monitor weekly charges and work files. Assure weekly completion of hospital missing charge lists and report physician in noncompliance of divisional/departmental missing operative note policy. Assure OPBC and Departmental compliance guidelines applied to billed services. Serve as compliance liaison to WU Office of Physician Billing Compliance. Working Conditions: Job Location/Working Conditions: Normal office environment. Physical Effort: Typically sitting at a desk or table. Equipment: Office equipment. The above statements are intended to describe the general nature and level of work performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all job duties performed by the personnel so classified. Management reserves the right to revise or amend duties at any time. Required Qualifications Education: Bachelors degree or combination of education and/or experience may substitute for minimum education. Certifications/Professional Licenses: No specific certification/professional license is required for this position. Work Experience: Supervisory (5 Years) Skills: Not Applicable Driver's License: A driver's license is not required for this position. More About This Job Preferred Qualifications: AAPC (American Academy of Professional Coders). CPC (Certified Professional Coder). CCC (Certified Cardiology Coder). RHIT (Registered Health Information Technician) from AHIMA. Ability to ask questions about conditions/diseases including understanding signs of deterioration and the risks of morbidity. Preferred Qualifications Education: No additional education unless stated elsewhere in the job posting. Certifications/Professional Licenses: Certified Documentation Expert Outpatient (CDEO) - American Academy of Professional Coders (AAPC) Work Experience: No additional work experience unless stated elsewhere in the job posting. Skills: Accounting, Code Compliance, Organizing, Supervisory Management, Trend Analysis, Trend Reporting Grade C13 Salary Range $68,100.00 - $105,500.00 / Annually The salary range reflects base salaries paid for positions in a given job grade across the University. Individual rates within the range will be determined by factors including one's qualifications and performance, equity with others in the department, market rates for positions within the same grade and department budget. Questions For frequently asked questions about the application process, please refer to our External Applicant FAQ. Accommodation If you are unable to use our online application system and would like an accommodation, please email CandidateQuestions@wustl.edu or call the dedicated accommodation inquiry number at 314-935-1149 and leave a voicemail with the nature of your request. All qualified individuals must be able to perform the essential functions of the position satisfactorily and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions of their job, absent undue hardship. Pre-Employment Screening All external candidates receiving an offer for employment will be required to submit to pre-employment screening for this position. The screenings will include criminal background check and, as applicable for the position, other background checks, drug screen, an employment and education or licensure/certification verification, physical examination, certain vaccinations and/or governmental registry checks. All offers are contingent upon successful completion of required screening. Benefits Statement Personal Up to 22 days of vacation, 10 recognized holidays, and sick time. Competitive health insurance packages with priority appointments and lower copays/coinsurance. Take advantage of our free Metro transit U-Pass for eligible employees. WashU provides eligible employees with a defined contribution (403(b)) Retirement Savings Plan, which combines employee contributions and university contributions starting at 7%. Wellness Wellness challenges, annual health screenings, mental health resources, mindfulness programs and courses, employee assistance program (EAP), financial resources, access to dietitians, and more! Family We offer 4 weeks of caregiver leave to bond with your new child. Family care resources are also available for your continued childcare needs. Need adult care? Weve got you covered. WashU covers the cost of tuition for you and your family, including dependent undergraduate-level college tuition up to 100% at WashU and 40% elsewhere after seven years with us. For policies, detailed benefits, and eligibility, please visit: https://hr.wustl.edu/benefits/ EEO Statement Washington University in St. Louis is committed to the principles and practices of equal employment opportunity and especially encourages applications by those from underrepresented groups. It is the Universitys policy to provide equal opportunity and access to persons in all job titles without regard to race, ethnicity, color, national origin, age, religion, sex, sexual orientation, gender identity or expression, disability, protected veteran status, or genetic information. Washington University is dedicated to building a community of individuals who are committed to contributing to an inclusive environment fostering respect for all and welcoming individuals from diverse backgrounds, experiences and perspectives. Individuals with a commitment to these values are encouraged to apply. Should I consider applying to older job postings? Yes. Due to the unique needs of each search, the selection process may occur at different paces for open positions. Individuals are encouraged to apply to all open positions of interest for which they meet the Required Qualifications. Washington University in St. Louis' collective success is significantly attributed to the passion and outstanding efforts of our community. Our staff, faculty and trainees are committed to excellence and dedicated to carrying out our missions of research, teaching and patient care. WashU prides itself on being a place where people matter, and serious work is done. Our people work together in an inclusive community that celebrates diverse perspectives, collaboration and innovation. We are a community of individuals inspired to work together to develop big ideas and tackle challenging problems. We value the well-being of our people. WashU strives to create a positive employee experience where staff, faculty and trainees thrive, both personally and professionally. Our employees find meaning, connection and vitality in their work and life with a healthy work-life balance and support to learn, grow and make an impact at WashU, the community and the world. Useful Links Who We Are Human Resources Benefits Living in St. Louis Frequently Asked Questions Accommodation If you are unable to use our online application system and would like an accommodation, please email CandidateQuestions@wustl.edu or call the dedicated accommodation inquiry number at 314-935-1149 and leave a voicemail with the nature of your request. Regulatory Postings Know Your Rights: Workplace Discrimination is Illegal Poster (English; Spanish)