Role : General Manager/Assistant Vice President - Medical Coding Operations for a BPO

A global Business Process Management (BPM) services provider with presence in USA, Canada, UK, Jamaica, India and Philippines and 44,000 employees globally

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-9-CM, 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.

MINIMUM JOB REQUIREMENTS: (Education, Experience, Skills)

14-25 years experience, of which an overall 8+ years in the Medical coding area with a BPO.

Knowledge prerequisites

1. Certified Professional Coder (AAPC), Certified Coding Specialist (AHIMA) or Certified Coding Specialist - Physician based (AHIMA) - one of the above is a must

2. Very good or above average communication skills, look for profiles who have engaged first hand in an Sales cycle ( RFI/P, Due Diligence, Prospect Visit etc. )

3. 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.

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

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

6. The APC structure and regulatory requirements.

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

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

This job opening was posted long time back. It may not be active. Nor was it removed by the recruiter. Please use your discretion.