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Supervisor, Medical Review Coding
Job Code:2019-50-4-001
Location:Sunrise, FL
Status:Regular Full Time
  
Responsibilities:

The Supervisor, Medical Review Coding is responsiblefor the oversight of a team in both a local or in a remote setting.  The role communicates and supports the achievement of the organizational goals by managing employee performance and inventory. 
  • Supervise daily activities of administrative and/or professional audit staff members.
  • Provide audit guidance to medical review coders; identify trends and present solutions for improvement.
  • Monitor and manage individual team and overall inventory to ensure timelines are met.  Use reports and experience to proactively identify potential backlogs and align resources to meet business needs.
  • Routinely provide production and quality performance based feedback and progress reports to staff. Initiates corrective action plans as needed.
  • Oversee and review audit determinations in order to ensure consistency in decision-making. Support quality assurance as necessary.
  • Participate in internal and external meetings and conference calls with other medical review entities.  Collaborate with other departments to resolve problems.
  • Conduct team meetings with direct reports on a regular basis. Promote open communication with team, peers, and management.
  • Resolve conflicts and provide leadership to team members. Escalate issues as needed and provide solutions to potential problems.
  • Complete and conduct annual performance reviews for assigned staff.
  • Position may be responsible for supporting the development of training materials and/or conducting training of new or existing staff.     
  • Participate in the development and updates of Medical Review Guidelines as necessary.
  • Deliver on commitments, become a subject matter expert.
  • Interface with and support the Medical Director.
  • Keep up to date of changes that affect our industry as it pertains to regulations, legislation and business trends.
  • Analyze information, evaluate processes, anticipate business needs, and make recommendations. 
  • Support internal departments in the development, enhancement and identification of edit parameters and appeals reviews as requested.
  • Perform other incidental and related duties as required and assigned.

Required Skills and Knowledge:

              
  • Excellent communication skills both verbal and written; ability to communicate at all levels within the organization both internal and external.
  • Excellent time management, organizational, and prioritization skills and ability to balance multiple priorities.
  • Strong critical thinking, questioning, and listening skills; excellent attention to detail.
  • Ability to work independently in a remote or office setting.
  • Effective business decision making skills and problem solving that includes taking calculated risks. 
  • Experience in inventory management, resource planning and report generation.
  • Skill in analyzing information, identifying trends and presenting solutions.
  • Strong knowledge of medical documentation requirements and an understanding CMS, Medicaid and/or Commercial insurance programs, particularly the coverage and payment rules.
  • Thorough working knowledge of CPT/HCPCs/ICD-9/ICD-10/MS-DRG coding.
  • Experience in developing, documenting and implementing process and procedures. 
  • Professional attitude. Willing to lead, communicate ideas, take initiative and drive the team to achieve organizational goals.
  • Ability to be flexible and thrive in a high pace environment with changing priorities.
  • Typing skills and intermediate level experience with MS Office products including Excel, Word and Powerpoint.
  • Travel may be required.

 

Education and Experience:
        
  • 5+ year’s in supervisory or leadership role to include oversight of remote staff.
  • 3+ years of DRG coding for hospital, physician’s office or other acute inpatient facility setting, OR equivalent demonstrated experienced gained through prior experience conducting inpatient coding reviews.
  • Certification as a CPC, CPC-H, CPC-P, RHIA, RHIT, CCS, or CCS-P
  • Prior auditing experience in a provider setting, or as a payor for a health insurance company.
  • Edit development, and/or coding and reimbursement policy knowledge a plus.