UPMC Corporate Revenue Cycle is seeking an experienced Senior Manager to lead our Coding Department. This fully remote position operates within standard business hours, Monday through Friday. We are looking for someone who has strong professional coding experience, as well as knowledge of other coding areas.
As the Senior Manager you will provide direction, planning and creative solutions for the day-to-day operations of the Central Coding Department, as well as oversight, auditing and monitoring of all non-centralized coding for all UPMC entities/groups. The Senior Manager is responsible for developing and implementing process changes that result in a reduction of cost, aligning UPMC core values and focusing on sound business practices and customer-centered environment to create the ideal customer experience. In this role, you will work closely with all UPMC business units to maintain the highest levels of quality, satisfaction and revenue maximization in a manner that complies with standards established by UPMC and outside regulatory and accreditation agencies.
Responsibilities:
- Work closely with and cooperate fully with interdepartmental managers and staff to address and resolve all issues in a timely and complete manner. Develop Coding quarterly and annual department goals that ensure department growth, advancement of knowledge, expanded use of technology and ultimately contribute to the success of UPMC.
- Support quality improvement through internal programs, such as clinical documentation improvement. Ensure productivity goals and accuracy standards are established, monitored and enforced to support the overall department goal of lowering cost and improving net revenue. Ensure all coding is accurate, in compliance with all regulatory requirements and complete to receive optimal reimbursement for the documented service. Ensure timely edit and denial resolution. Perform analytics to prevent future errors and move denials upstream to be resolved through edits when appropriate.
- Perform duties and job responsibilities in a fashion that coincides with the service management philosophy of the Revenue Cycle Division, including the demonstration of the basics of service excellence towards patients, visitors, staff, peers, physicians, practice staff and other departments within the UPMC Health System. Lead evaluation of new practice implementations along with development of procedures and workflows related to coding, coding edits, denials and ensure appropriate mapping of all coding work queues. Ensure timely coding and posting of all services through report monitoring and implementing action plans to address backlogs.
- Assist with budget recommendations for area of responsibility as well as keeping expenses within budget. Perform on-going analysis to ensure manual processes are minimized and electronic/automated processes are implemented to lead to lower cost and improved net revenue. Ensure pro-active and reactive revenue cycle analysis to prevent and/or address any adverse effect on revenue cycle goals or A/R.
- Oversee numerous areas of specialty coding, utilizing managers and supervisors with a large workforce of coders. Ensure staffing complement in each area is appropriate for workload and is distributed to ensure most efficient workflow. Work with payors to resolve issues related to new or experimental procedures.
- Maintain current knowledge of federal and state regulations related to third-party billing, coding, reimbursement and collections. Work closely with the Quality Assurance Department to assess coding accuracy. Assist with the development of necessary education for areas of concern or new coding guidelines. Develop and implement Coding processes and workflows to enhance productivity, ensure accuracy and promote optimized reimbursement. Develop methods to ensure compliance of all established protocols.
- Perform ongoing reviews of processes, market trends and payer/regulatory changes to identify areas of process improvement that reduce the dollars and resource investment in accounts receivable, enhance patient satisfaction and keep the institution from any risk related issues. Investigate current processes/procedures to ensure all revenue opportunities are being realized.Assist with special projects as needed.
- Work closely with Sr. Physician division management, Department Administrators, Department Chairs as well as other appropriate senior Physicians, and Sr. Hospital Management to ensure all revenue cycle related goals are met, A/R is appropriately managed, and financial progress is attained. Represent Coding in internal or external meetings.Address all escalated issues in an urgent manner to ensure positive outcome and optimal patient satisfaction.
Qualifications:
- Bachelor’s degree and four years of relevant experience
- or Certificate/Diploma from a Technical School and five years of progressive revenue cycle experience within a professional billing or healthcare environment
- or ten years total, progressive revenue cycle experience within a professional billing or healthcare environment.
- Five years of previous coding management is required.
- Strong analytical skills utilizing PC-based software applications required.
- Organization and time management skills.
- Ability to develop and maintain a working environment conducive to the education and training of staff.
- The incumbent must develop and manage relationships with colleagues in a professional, independent manner.
- The position requires the ability to maintain confidentiality with regard to all assignments.
- Must possess analytical problem-solving skills as well as the ability to coordinate the work of others and communicate effectively, both written, and orally with individuals or large groups, including all levels of management.
- Thorough knowledge of CPT-4 and ICD-10 coding. Must demonstrate strong interpersonal and communication skills.
- Must be highly agile, demonstrate critical thinking skills and able to function in a high-pressure environment with very little direct supervision.
- Requires flexibility in working long hours and off days.
Licensure, Certifications, and Clearances:
- Applicable Coding credentials and/or Certification preferred.
- Act 34
UPMC is an Equal Opportunity Employer/Disability/Veteran
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