Director, Coding - Revenue Cycle

Job Description:

Develops, coordinates, and directs of all coding activities related to the revenue cycle. The Director of Coding ensures accurate and timely coding of all hospital, professional and clinical services at UTMB. This position actively establishes policy and procedure both internally within the Revenue Cycle as well as throughout the institution to ensure compliance with all Federal and State-mandated billing and coding laws. The Director of Coding is responsible for managing critical key indicators and direct supervision of professional and clinical coding.

Job Functions:

• Under the direction of the Vice President of Revenue Cycle, actively manages Hospital and Professional coding operations for UTMB to promote compliance with Federal, State and professional requirements for physician and hospital documentation, coding and billing standards.
• Oversee the coding team’s roles and responsibilities in order to execute continuous improvement of processes.  Utilize people, processes and technologies to improve efficiency, effectiveness, service quality to reduce case backlogs and cycle times so that overall performance metrics are optimized.
• Participate as needed in all Revenue Cycle project related decisions including staffing, deliverable acceptance, change management and communications.
• The position must consider processes and implement functions that comply with UT System Policies, Federal and State Statutes, and the institution’s policies and procedures regarding revenue capture, coding compliance, financial controls, and audit inquiries.
• Responsible for interviewing and selecting assigned staff positions for UTMB Hospital and Professional Coding. Monitors and maintains UTMB coding staff productivity.
• Provide support to strategic projects that interact / overlap / or has dependencies with Epic.
• Perform training, management, evaluation and counseling of assigned staff, including disciplinary actions up to termination when needed.
• Maintain personal and professional growth and development through seminars, workshops and professional affiliations. Establishes goals and objectives for employees to measure performance and provide cross training to meet mutually agreed-upon expectations and provides employees access to resources needed to progress in their development plans.
• Actively participates as coding, documentation and billing resource and consultant for physicians, mid-level providers, practice administrators and other staff. Works to resolve coding, documentation and billing issues timely and facilitates communication of coding related matters.
• Identifies process improvement opportunities for physician and clinical coding to achieve high quality outcomes in physician and hospital CPT, ICD-10, HCPCS, DRG and PCS coding, documentation and billing.
• Oversee the development, implementation, dissemination, and adherence to policy and procedures related to physician and hospital coding, documentation, and billing activities.
• Develop, implement and monitor coding and documentation education/training program for physicians, mid-level providers and clinic staff to promote Federal and state regulatory compliance, as well as physician coding and documentation compliance.
• Develop and present physician and clinical coding progress and summary reports or presentations to physicians and executive leadership.
• Serve as subject matter expert on accurate and appropriate physician and clinical coding and documentation standards, guidelines and regulatory requirements.
• Develops an annual physician and clinical coding work plan that addresses physician and clinical coding issues and areas of risk.
• Manages curriculum development and strategic delivery used to educate physicians and other clinical staff in documentation and coding. Identifies appropriate resource materials used to enable physicians and staff to comply with documentation and coding requirements.
• Assist with developing and maintains UTMB physician and clinical coding policies and procedures. Periodically reviews, updates and adds policies and procedures as needed with the approval of the UTMB leadership.
• Develop, implement and directly oversee audits and investigations of professional coding diagnosis, procedure coding, E/M leveling and charge entry for UTMB providers.
• Develops programs and models to support document driven, compliant physician and clinical coding based on external regulatory and accreditation requirements as well as internal policies, procedures and coding guidelines.
• Provide full operational management and leadership to optimize and maintain efficient coding processes and best practice use of the electronic medical record, computer-assisted coding and clinical documentation software, and other related technologies.
• Perform special projects as assigned by the Vice President of Revenue Cycle Operations
• Knowledge of large scale hospital and or professional revenue coding operations and clinical implications, information systems, analytical and planning skills. Must demonstrate professional judgment, independent decision making abilities, extremely strong interpersonal and communication skills, excellent supervisory skills, and the ability to function under pressure due to time constraints
• Responsible for the coordination and provision of personnel and capital resources for revenue cycle operations.
• Identifies and initiates improvements/efficiencies to the revenue cycle for both professional and hospital revenue.
• Provides guidance and instruction in the interpretation of policies, procedures, and regulations.
• Monitors changes in Federal Regulations and advises departments of the impact of pending regulation changes. Establishes policy to ensure compliance with all Federal MD regulations and insurance company requirements related to the revenue cycle for UTMB Hospitals and Clinics.
• Interacts with multidisciplinary personnel, including Chairmen, Institutional Leadership, Department Directors, etc., to ensure that processes are developed and maintained to maximize reimbursement to UTMB Hospitals and Clinics.
• Develops plans for recruitment and retention of direct subordinates and oversees the recruitment and retention of management and operational staff.
• Other duties as assigned.

Knowledge/Skills/Abilities:

• Knowledge of federal and state collection laws, Medicare, Medicaid, and other third-party pay or regulatory requirements.
• Thorough knowledge of physician reimbursement and managed care contract issues.
• Knowledge of automated systems that support physicians billing services.
• General knowledge of medical terminology and trends related to disease processes and technology available for detection and treatment.
• Strong communication and interpersonal skills with a high degree of professionalism in dealing with staff at all levels of the institution.
• Excellent relationship-builder and communicator and extensive knowledge of health care operations and physician group practices.
• Effective problem solving skills.
• Ability to develop, prioritize, and accomplish goals.
• Ability to analyze and evaluate data and make appropriate decisions/recommendations.
• Demonstrated project management and performance improvement skills.