Lakeland Regional Health

Position Details

Work Hours per Biweekly Pay Period: 80

Shift: Days

Location: Hybrid - 210 South Florida Avenue Lakeland, FL

Pay Rate: Min $70,324.80 Mid $87,900.80

Qualifications & Experience

Essential: High School or Equivalent

Experience Essential:

5+ years of coding and auditing experience; knowledge of and working experience in professional billing and healthcare reimbursement and coding experience.

5+ years prior supervisory/management experience or in a coordinator/lead role.

Certification Essential:

CPC, CCS-P, or CCS with two or more additional AAPC Specialty Medical Coding Certifications

Certification Preferred:

AAPC Certified Professional Medical Auditor (CPMA), Certified Evaluation and

Management Coder (CEMC), Certified Risk Adjustment Coder (CRC)

Position Summary

Under the direction of the Associate Vice President of Health Information Management, the Provider Coding Compliance Education Supervisor is responsible for developing, updating, implementing, and managing a Provider Coding Compliance Education Plan to ensure accurate and compliant medical coding and billing practices consistent with CMS, Office of Inspector General (OIG), ICD-10 Official Guidelines for Coding and Reporting, and other applicable rules or guidelines. The Supervisor will oversee and provide coding, documentation, and general compliance education as it applies to providers; and identifies, validates, and ensures professional billing and coding compliance for providers through the evaluation of billing patterns, routine audits, and comprehensive educational sessions focusing on areas of specialty and risk assessment. The Supervisor is responsible for developing and implementing ongoing coding training and auditing of medical record documentation to ensure compliance; providing education; providing assessment and tracking of documentation compliance and improvement; and monitoring the need for process improvements or enhancements.

The Supervisor will evaluate new patient services, appropriate billing, documentation, and reimbursements to ensure maximization of revenue in a compliant environment. The Supervisor will oversee the review of all new, onboarded providers to validate and ensure coding and billing compliance as well as provide immediate feedback and education. The Supervisor will provide consultative services to clinical practices to include evaluation of services provided, appropriate coding and billing, and documentation. The Supervisor will be included with third-party payer coding reviews and documentation findings with follow-up of recommendations.

The Supervisor will oversee the risk adjustment program which is responsible for ensuring proper risk adjustment coding by performing audits of providers; ensuring accurate representation of the care provided; ensuring accuracy in the HCC codes reported; and provider education.

The Supervisor will work collaboratively with Corporate Integrity Services and the Revenue Cycle Management personnel such as the LRHPG Coding Manager and the Director of Clinical Documentation Integrity to standardize provider documentation education efforts. The Supervisor will also work collaboratively with the Providers, staff, and others as may be deemed appropriate.

Position Responsibilities

People at The Heart Of All That We Do

• Fosters an inclusive and engaged environment through teamwork and collaboration.
• Ensures patients and families have the best possible experiences across the continuum of care.
• Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created.

Safety And Performance Improvement

• Behaves in a mindful manner focused on self, patient, visitor, and team safety.
• Demonstrates accountability and commitment to quality work.
• Participates actively in process improvement and adoption of standard work.

Stewardship

• Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities.
• Knows and adheres to organizational and department policies and procedures.

People At The Heart Of All We Do

• Fosters an inclusive and engaged environment through teamwork and collaboration.
• Ensures patients and families have the best possible experiences across the continuum of care.
• Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created.
• Safety And Performance Improvement
  • Behaves in a mindful manner focused on self, patient, visitor, and team safety.
  • Demonstrates accountability and commitment to quality work.
  • Participates actively in process improvement and adoption of standard work.
  • Stewardship
  • Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities.
  • Knows and adheres to organizational and department policies and procedures.
  • Standard Work: Provider Coding Compliance Education Supervisor
  • Develops, updates, implements, and manages a Provider Coding Compliance Education Plan to ensure accurate and compliant medical coding and billing practices consistent with CMS, Office of Inspector General (OIG), ICD-10 Official Guidelines for Coding and Reporting, and other applicable rules or guidelines.
  • Ensures the Provider Coding Compliance Education Plan covers regulatory compliance, accurate reimbursement, fraud and abuse prevention, documentation improvement and ethical coding practices.
  • Collaborates with Corporate Integrity Services and Revenue Cycle Management leaders to develop provider coding policies and procedures; coding audits and monitoring; education and training; reporting mechanisms; corrective action; and documentation improvement initiatives.
  • Oversees the Provider Coding Compliance Education Specialist and Risk Adjustment Coder's responsibilities of ensuring professional billing and coding compliance for providers through the evaluation of billing patterns, routine audits, and comprehensive educational sessions focusing on areas of specialty and risk assessment.
  • Evaluates new patient services, appropriate billing, documentation, and reimbursements to ensure maximization of revenue in a compliant environment. Oversees the review of all new, onboarded providers to validate and ensure coding and billing compliance as well as provide immediate feedback and education.
  • Develops and implements ongoing coding training and auditing of medical record documentation to ensure compliance; providing education; providing assessment and tracking of documentation compliance and improvement; and monitoring the need for process improvements or enhancements.
  • Provides consultative services to clinical practices to include evaluation of services provided, appropriate coding and billing, and documentation. The Supervisor will be included with third-party payer coding reviews and documentation findings with follow-up of recommendations.
  • Maintains current knowledge of all HEDIS, HCC and related coding measures using all available and relevant government and insurance resources.
  • Works collaboratively with the LRHPG Coding Manager and the Director of Clinical Documentation Integrity to standardize provider documentation education in an effort to not provide conflicting education regarding inpatient and outpatient documentation.
  • Provides regular coding guidance and continuous feedback to all physicians and APP's on validation findings to support compliant coding and to provide education when appropriate to increase coding knowledge and skills. Schedules meetings with providers to review audit findings and provides training and education as appropriate.

Competencies & Skills

Essential:

• Excellent knowledge of CPT-4, ICD-10-CM and HCPCS coding principles, governmental regulations, protocols and third-party payer requirements pertaining to billing, coding and documentation. Strong knowledge of HCC and risk adjustment scoring.
• Excellent computer skills with knowledge of electronic health records (EHRs) and is proficient in Microsoft Office, and generating reports.
• Strong interpersonal, analytical, presentation, and writing skills required for proposal and report development. Ability to plan and execute educational programs and presentations.
• Strong organizational skills with attention to detail. Ability to prioritize provider medical record reviews/projects and provider coding education opportunities with alignment with audits and overall trends.