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Manager, Medical Review - Coding
Job Code:2018-50-6-024
Location:Remote - Sunrise, FL
Status:Regular Full Time
The Manager, Medical Review - Coding is a key member of the Healthcare Services organization responsible for managing and leading on-site and remote medical coding professionals in the timely delivery of high quality audit work for our clients.  The role provides direct oversight and has responsibility for developing approaches that optimize the department’s ability to achieve and exceed client requirements and business objectives in support of division strategy. 

Essential Duties:
•Develops and executes audit plans in accordance with client statement of work, compliance and company requirements.
•Provide audit guidance to medical review coders; identify trends, develop and implement solutions that optimize performance of the department.  
•Applies in-depth expertise in both inpatient and outpatient medical coding to the development of policies, procedures, guidelines, coding issues/refining coding parameters, workflow and tools.
•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. 
•Hires, trains and develops staff; Proactively manages team production and quality performance, and: resolves conflict in a tactful and effective manner.
•Monitors and analyzes audit productivity and quality; identifies trends, determines root causes of inconsistencies or issues, and; develops and implements tools, training and solutions for resolving issues and continuous improvement.  
•Effectively collaborates and builds credibility internally and externally; Leverages strong professional communication skills to effectively engage with and influence a wide range of internal and external audiences. 
•Leverages strong industry and business knowledge to support strategy by conducting needs assessments, capacity planning, cost/benefit analysis, preparing staffing models, and establishing productivity and quality standards. 
•Maintains professional and technical knowledge by keep up to date of changes and emerging trends that affect our industry as it pertains to regulations, legislation and business trends. 
•Support internal departments in the development, enhancement and identification of edit parameters and appeals reviews as requested.
•Travel infrequently as may be required to meet business needs.
•Perform other incidental and related duties as required and assigned.
Required Skills and Knowledge:
•Broad and comprehensive knowledge and understanding of medical documentation requirements and an understanding CMS, Medicaid and/or Commercial insurance programs, particularly the coverage and payment/reimbursement rules.
•Thorough working knowledge of CPT/HCPCs/ICD-9/ICD-10/MS-DRG coding and demonstrated capability in developing and implementing effective coding audit strategies.
•Excellent verbal and written communication and interpersonal skills; ability to effectively communicate at all levels within the organization both internal and external.
•Strong project and operations management skills; inventory management, resource planning, developing and leveraging reports; developing policies and procedures.
•Leverages strong analytical, critical thinking and problem-solving skills; Skill in analyzing information, identifying trends and presenting solutions.
•Demonstrated ability to apply excellent judgement and decision-making skills.
•Demonstrated success building and lead high performing teams. 
•Adaptable and thrives in a fast-paced dynamic environment with changing priorities. 
•Strong computer skills; intermediate level experience with MS Office products including Outlook, Excel, Word and PowerPoint.
•Ability to travel from time to time.

Physical Requirements:
Performs duties in a busy standard office environment with moderate noise level.
•Sits at a desk during scheduled shift; standing, walking and reaching as needed to use office equipment.
•Makes and returns calls using an office phone system; 
•Views a computer monitor, types on a keyboard and uses a mouse. 
•Reads and comprehends information in electronic (computer) or paper form (written/printed). 
•Types frequently, but not constantly, using a keyboard and mouse. 
•Occasionally lifts/carries/pushes/pulls up to 10lbs
•Travel as may be required to meet business needs.
Education and Experience:
•BA/BS, or equivalent combination of relevant education and experience.
•7+ years of coding experience. Must include sufficient depth and breadth of outpatient and inpatient/DRG coding - 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. 
•10+ years of progressive healthcare experience, with a minimum of 3 years in management that includes oversite for staff in multiple locations.
•Experience developing coding issues and refining coding parameters for audit.
•Certification as a CPC, CPC-H, CPC-P, RHIA, RHIT, CCS, or CCS-P
•Significant auditing experience in a provider setting, or as a payor for a health insurance company.

Other Requirements:

*Must submit to and pass background check. Must not have any Federal or State liens resulting from County, State or Federal tax issues.  Must not have any current defaulted student loans.
*Must be able to pass a criminal background check; must not have any felony convictions or specific misdemeanors.
*Must submit to and pass drug screen.
*Performant is a government contractor. Certain client assignments for this position may require additional background and/or clearances.

Job Profile is subject to change at any time.

Performant Financial Corporation is an Equal Opportunity Employer. Performant Financial Corporation is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law.