The Wright Center for Graduate Medical Education · 1 month ago
Manager, Revenue Cycle & Coding Compliance
Scranton, PA
Full-time
Onsite
Senior Level
7+ years expThe Wright Center for Graduate Medical Education is seeking a Manager of Revenue Cycle and Coding Compliance. This role is responsible for overseeing the coding and billing processes for inpatient and outpatient claims, ensuring compliance with regulations, and managing the coding and training teams to maximize revenue.
Higher Education
Responsibilities
Perform accurate and timely multi-specialty coding for daily claims submission
Prepare and submit clean claims to third-party payers working closely with clinical team members regarding claims appeal, denial, and resolution
Develop and maintain the ongoing audit process of the daily billing summary reviewing the quality of the clinical documentation and coded data to validate that the documentation supports services rendered while ensuring the integrity of the coding
Respond timely (either orally or written) to account inquiries from patients, third-party payers, clinical providers, and/or other staff on claims submission
Manage the daily workload of the billing specialist
Monitor AR over 120 Days
Perform ongoing trend analysis to ensure compliant contractual third-party payer reimbursement and work with appropriate individuals to resolve discrepancies
Prepare/review monthly aging reports
Establish and monitor best practice and standards to control the integrity and quality of data throughout the revenue cycle
Actively participate in staff development, training and assessments to support industry best practice
Ensure compliance with federal/state laws and regulations and billing and collection policies in order to facilitate attainment of account receivable targets
Interact with physicians, learners and other patient care providers on daily basis regarding billing and documentation policies, procedures, and regulations to ensure receipt and analysis of all charges; obtains clarification of conflicting, ambiguous, or non-specific documentation; as well as develop working relationship with operational leaders
Perform and monitor all steps in the billing and coding process to ensure maximum reimbursement from patients, third-party payers as well as from special billing arrangements
Develop, implement and oversee clinical provider and learner education performed by Trainer and Educational Liaison to ensure coding quality. Must have capacity to attend meetings day/evening as needed within assigned areas
Participate in clinical huddles/didactics and other clinical meetings as requested
Develop, implement and maintain billing and coding educational materials used in clinical provider and learner training, including the creation and ongoing maintenance of training protocol documents of the clinical workflow, including Medent usage
Develop, implement and maintain population management learner training program addressing inpatient/outpatient chart review. Provide meaningful feedback and ongoing support and monitor to ensure residents have the knowledge needed
Serve as resource and subject matter expert for all billing and coding matters
Oversee and monitor the coding compliance program. Develop and coordinate educational and training programs regarding elements of the coding compliance such as appropriate documentation and accurate coding to all appropriate staff including coding staff, physicians, learners, other clinical providers and operational departments. Ensures the appropriate dissemination and communication of regulatory, policy and guideline changes
Understand all aspects of Federally Qualified Health Center (FQHC) coverage, coding, billing and reimbursement of patient services, as well as other third-party payers
Understand Medicare, Medicaid and other commercial payer rules and regulations applicable to billing/coding
Understand the considerations of coding in Value Based payment contracts
Follow coding/billing guidelines and legal requirements to ensure compliance with federal and state regulations
Manage multiple priorities and projects with competing deadlines
Serve as a coach and mentor for coding team. Assist team with projects as needed
Maintain strictest confidentiality; adhere to all HIPAA guidelines/regulations
Other duties as assigned by management
Qualification
Required
Bachelor or Associate degree in any Healthcare related field or equivalent experience
Must be a Certified Professional Coder with 7-10 years minimum direct professional coding experience
Must have strong knowledge of all guidelines for ICD-10, CPT/HCPCS codes, medical terminology, and billing processes
Knowledge of Medical Billing/EHR (Electronic Health Records) systems preferably Medent
Knowledge of EOBs (Explanation of Benefit), EFTs (Electronic Funds Transfer) and ERAs (Electronic Remittance Advice)
Knowledge of Microsoft Office software
Must possess team leadership skills and have a positive disposition
Must be focused, self-directed, & organized, with problem-solving abilities
Accurate and precise attention to detail
Excellent verbal and written communication skills
Certified Professional Coder-CPC
Preferred
Certified Risk Adjustment Coder-CRC (not required but a plus)
Certified Professional Compliance Officer Certification – CPCO (not required but a plus)
FQHC billing helpful (not required but a plus)
5 to 7 year minimum experience managing staff within the patient revenue cycle
General working knowledge/previous exposure of healthcare environments and auditing concepts, medical billing/operations, medical terminology and clinical documentation
Company
The Wright Center for Graduate Medical Education
The Wright Center’s Internal Medicine, Family Medicine and Psychiatry Residencies, as well as our Cardiovascular Disease and Gastroenterology Fellowships, were designed to empower residents as innovators and nimble leaders responsive to the needs of the community they serve.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Linda Thomas-Hemak
President and CEO
Sandra Yastremski CPA
Chief Financial Officer
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