Manager, Coding Compliance - Pediatrics Central Administration

About this role

Location SAINT LOUIS, MO 63110

 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 ensuring 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:

• Supervises Coding Coordinators to ensure hospital-based services captured timely and to maximize revenue. • Directly interacts and communicates with faculty on coding, charge capture, compliance and other billing related issues. • Performs compliance related duties such as review of medical documentation, completion of physician audits and OPBC audits. • Develops educational material and conducts regular meetings with faculty to determine methods of improving coding and documentation. • Ensures staff attends scheduled training/in-services. • Keeps abreast of procedures and changes affecting Medicare, Medicaid, HMO, PPO and related health care operations. • Communicates policies and procedures to staff on billing issues to promote efficient flow of billing process. • Monitors weekly charges, TES work files, MTC lists, approves write-offs per departmental policy. • Ensures weekly completion of hospital missing charge lists and report physician in noncompliance of divisional/departmental missing operative note policy. • Ensures OPBC and Departmental compliance guidelines applied to billed services. • Serves as compliance liaison to WU Office of Physician Billing Compliance. • Performs other duties as assigned.

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: Bachelor’s 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 WashU seeks highly motivated individuals who are able to perform duties in a manner consistent with our core mission and guiding principles.

Preferred Qualifications

Education: No additional education unless stated elsewhere in the job posting. Certifications /Professional Licenses : No additional certification/professional licenses unless stated elsewhere in the job posting. Work Experience: No additional work experience unless stated elsewhere in the job posting.

Skills: Accounting, Code Compliance, Coding Compliance, Compliance Management, Healthcare Auditing, Health Care Regulation, Health Insurance Portability & Accountability Act (HIPAA), ICD Coding, Medical Billing and Coding, Organizing, Supervisory Management, Trend Analysis, Trend Reporting

Grade C13

Salary Range $70,600.00 - $109,500.00 / 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 check

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