General Manager/Assistant Vice President - Healthcare Coding - BPO

LOCATION - HYDERABAD

Position : GM / AVP - CODING ( Healthcare )

CTC : Negotiable ; depending upon last drawn CTC, total experience

JOB PURPOSE :

- The overall responsibilities for this job are to ensure client satisfaction and retention on current accounts and to help grow existing ones by identification of opportunities for enhancing services offered and ensuring the operational performance standards are met.

PRINCIPAL DUTIES AND RESPONSIBILITIES :

1. Supervises and performs a wide range of activities pertaining to the review and coding of inpatient and outpatient medical record information.

2. Establishes, implements and maintains a formalized review process for coding compliance, including a formal review (audit) process; designs and uses audit tools to monitor the accuracy of clinical coding.

3. Performs data quality reviews on inpatient records to validate the International Classification of Diseases Manual (ICD-9-CM), ICD-10-CM / PCS and other codes; verifies Diagnosis Related Group (DRG) group appropriateness; checks for missed secondary diagnoses and procedures and ensures compliance with all DRG mandates and reporting requirements; monitors Medicare and other DRG paid bulletins and manuals, and reviews the current Office of the Inspector General (OIG) work plans for DRG risk areas.

4. Performs data quality reviews on outpatient encounters to validate the ICD-9CM, ICD-10-CM / PCS, the Current Procedural Terminology (CPT), and the Healthcare Common Procedure Coding System (HCPCS) Level II code and modifier assignments; verifies Ambulatory Payment Classification (APC) group appropriateness; checks for missed secondary diagnoses and/or procedures; ensures compliance with all APC mandates and outpatient reporting requirements; monitors medical visit code selection against facility-specific criteria for appropriateness; assists in the development of such criteria as needed. Allocates resources and removes obstacles.

5. Continuously evaluates the quality of clinical documentation to identify incomplete or inconsistent documentation for inpatient and/or outpatient encounters that impact the code selection and resulting APC/DRG groups and payment; brings concerns to the attention of the Client for resolution.

6. Maintains knowledge of current and required coding certifications as appropriate; may perform the most technical complex and difficult coding and abstraction work.

7. Selects, assigns, and trains subordinate technical and clerical staff; directs, monitors and evaluates work; reviews and makes decisions regarding leave requests; initiates and implements disciplinary action as needed; assists with and promotes the recruitment and retention of qualified staff as assigned. Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association; reports areas of concern to the VP of Operations or Compliance, as appropriate.

8. Attends coding and reimbursement workshops as appropriate; communicates any DRG/APC updates published in third-party payer newsletters, bulletins and/or provider manuals; shares information with coding team as directed.

9. Stays informed about transaction code sets, Health Insurance Portability and Accountability Act (HIPAA) requirements and other future issues impacting health information management functions; keeps abreast of new technology in coding and abstracting software and other forms of automation.

10. Demonstrates and maintains competency in the use of computer applications, particularly the coding and abstracting software and hardware currently in use by the Customers.

11. Performs other related duties as assigned.

The above statements are intended to indicate the general nature and level of work being performed by employees within this classification. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of employees assigned to this job. Employees in this job may perform other duties as assigned. In addition to the above, all HGS employees are expected to:

- Promote teamwork and cooperative effort. - Help train and give guidance to other HGS employees. - Maintain a clean, safe, and unobstructed work area, and practice good safety habits. - Provide internal and external customers with the highest quality service.

MINIMUM JOB REQUIREMENTS: (Education, Experience, Skills) -

A combination of experience, education, and/or training which substantially demonstrates the following knowledge, skills and abilities:

Knowledge : 

1. Principles and practices of hospital administration; principles and practices of leadership and supervision; principles of work planning and organization.

2. Advanced principles and practices of medical record keeping; advanced medical terminology, anatomy, and physiology, as well as the states, sequence, progression and description of diseases as they apply to medical record coding and abstraction.

3. Advanced functions of a hospital medical records division; legal aspects of medical record administration.

4. Advanced elements of ICD-9-CM, CPT, and HCPCS Level II coding systems.

5. The APC structure and regulatory requirements.

6. The current Diagnostic and Statistical Manual of Mental Disorders (e.g., DSM IV-TR) where clients have behavioral treatment centers.

7. Current hospital reimbursement systems and associated regulatory review practices.

8. Appropriate methods for auditing and reviewing information for quality control purposes.

9. The operation of standard office equipment; standard business computer hardware and software.

10. Possession of a national certification or registration in health information management coding from the American Health Information Management Association (AHIMA) as a Certified Coding Specialist (CCS), a Registered Health Information Technician (RHIT) or a Registered Health Information Administrator (RHIA).

Skills : 

1. The business and professional relationships and ethics involved among hospitals, physicians and patients.

2. Plan, assign and supervise specialized and routine medical records technical and clerical work.

3. Make difficult decisions regarding technical issues with substantial independence.

4. Read, interpret and evaluate complex technical reports and information.

5. Understand and apply anatomical, physiological and medical terminology.

6. Audit both outpatient and inpatient medical records to verify the appropriateness of diagnostic codes medical record abstracts.

7. Work with physicians and others to ensure complete and accurate information and optimal reimbursement based on coding and abstracting of medical records.

8. Operate a personal computer.

9. Maintain complex records, compile statistics and prepare complex technical reports.

10. Communicate clearly and concisely, both orally and in writing.

11. Provide excellent public relations and courteous customer service; establish and maintain cooperative working relationships with others including physicians, nurses, administrators, managers, vendors, contractors and other health care industry personnel.

COMPETENCIES:

- Competency Definition

- Uses Sound

- Judgment &

- Makes Decisions Wisely

- Surveys a situation quickly and grasps the issue or problem by asking probing questions. Develops sound business recommendations to achieve progress on global issues. Recognizes limits in resolving complex issues and teams with appropriate personnel to resolve issue. Reviews decisions to evaluate impact to long range goals.

Shows Initiative -

- Develops and leads the vision for the organization that will create an environment of empowerment and excellence. Ensures that management understands and is equipped with the necessary tools to lead. Looks for new ways to contribute to the business.

Promotes Teamwork

- Shares in-depth knowledge about the global environment to expand team understanding of relevant issues. Leads team supporting global initiatives. Participates in and facilitates internal and external collaborative efforts and arrangements.

- Communicates  Effectively

- Provides clear understanding of job priorities and expectations. Practices attentive and active listening.

- Conveys information to all levels of the organization.

- Leads and facilitates internal and external meetings.

- Embraces Differences Recognizes and models an understanding of the business value of diversity in team members. Assigns initiatives aligned with team members differences in strengths. Understands multiple voices create new ideas, new services and out of the box thinking.

Drives Customer Focus

- Establishes alliances with key customers and stakeholders. Drives the company strategies to focus on customer needs. Builds organization structures aligned with customer needs.

- Preferred Industry - IT, ITES, Reputed KPO, Big 4, Telecom, BPO .

Candidates who have been previously placed by TRUSTKLUB are requested to ignore, As a policy TRUSTKLUB does not intend to offer any candidate from an organisation with whom we are partners . Incase you are an unintended recipient by any means, where in both our firms are in partnership, request you not to apply to this position.

 Pls mention your current CTC and current LOCATION / ADDRESS details, Incase you want to relocate, pls mention reason.

TCPL