Responsible for serving as the operations point of contact for Medical Management and /or Medical Coding day to day operations, including but not limited to, facilitating issue resolution, meeting goals and targets.
Primary duties may include, but are not limited to:
- Acts as a liaison for both internal and external groups for program initiatives.
- Help create, launch and drive critical account initiatives and programs.
- Provides inputs to policies and processes impacting the operations.
- Manages a team of nurses and/or allied Healthcare professionals in the optimal execution of operations activities ensuring that each team member meets / exceeds their goals and metrics on a daily, weekly and monthly basis.
- Coordinates with workforce for staffing requirements and scheduling of agents given leaves, absences and attrition. Prepares reports. Hires, trains, coaches, counsels, and evaluates performance of direct reports. Suggests and develops high quality, high value, concept and or process improvement and efficiency recommendations.
Qualifications
- Registered Nurse license, either Philippines or unrestricted US territory.
- Minimum of 2 years hospital experience and/or several years of inpatient coding experience.
- Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing guidelines, payer reimbursement policies, and coding terminology preferred.
- One or more of the following certifications are preferred: Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC), or Inpatient Coding Credential such as CCS or CIC.
- Experience with third party DRG Coding and/or Clinical Validation Audits or hospital clinical documentation improvement experience preferred.
