System Director, Coding - Professional

Position Highlights:

• Position: System Director, Coding-Professional
• Hourly Pay Range: $56.18-$87.08/hour. The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors
• Location: Warrenville, IL
• Full Time/Part Time: Full Time
• Hours: Monday-Friday, [hours and flexible work schedules]
• Required Travel: Potential travel

Position Summary:
This position is responsible for leading the MG revenue cycle initiatives related to billing and coding support, including direct supervision of the coding support staff. The Director works in collaboration with Practice Managers and Admin Directors/AVPs, Information Systems, Medical Informatics, Coding and Chargemaster Compliance, the Hospital Business Office, and physician billing office to drive continuous improvements in the MG's revenue cycle performance. This includes identifying system-wide opportunities for improvement (both operational and technological), obtaining buy-in from key constituents (i.e., MG leadership), developing detailed workplans, and implementing the changes across the MG, involving appropriate parties as needed. In addition, the Director monitors and manages the day-to-day revenue cycle operations to ensure that direct reports, as well as the staff in the physician offices, are following prescribed workflows, meeting performance standards, and achieving goals

What you will do:

• Leads/manages the ongoing implementation/rollout of Claims Manager. This includes identification and prioritization of new flags, building or modifying flag logic, reviewing (or coordinating review of) reports to determine impact and accuracy of flags, development of testing plans and performing thorough testing, communicating rollout and educating appropriate staff, and calculating financial impact.
• Leads all aspects of other revenue cycle initiatives related to coding support, charge capture/review, and cash collections. This includes, but is not limited to, evaluation of technology, calculation of return on investment, project planning, implementation and management, staff education and training, and ongoing monitoring and optimization.
• Monitors trends and technology in the industry for new opportunities or issues for the MG. Works with VP to identify strategies and recommendations.
• Reviews all new Resolute functionality and works with the billing office to identify and prioritize those items that should be implemented within the MG. Works with the Epic teams to specify/customize the requested functionality and develops the recommended MG workflows for the office staff. Tests all functionality and workflows prior to implementation. Works with Epic training to develop training materials and classes. Clearly communicates all changes to the practices and troubleshoots any issues.
• Maintains comprehensive knowledge and understanding of all resolute functionality used in the offices and has general knowledge of functionality not activated. Proactively identifies system deficiencies and communicates enhancement requests.
• Identifies strategies for increasing cash collections within the offices and at other points of contact. With the ADs/AVPs and PMs, leads the development of workplans for implementing new strategies. Monitors performance post-implementation and provides feedback and recommendations to Managers and ADs on office performance.
• Develops and implements policies and procedures to ensure cash is handled and managed consistently across the Medical Group and in accordance with internal audit requirements and guidelines.
• Leads bi-weekly mtg of managers from revenue cycle, HBO, coding compliance, and physician billing office to identify and prioritize revenue cycle issues and to develop and implement plans for resolving them. This includes full discussion and investigation of coding opportunities and implications, Medicare and managed care regulations/guidelines, reimbursement, available technological support, and potential revenue impact. Maintains a current open and closed issues list, assigns responsibilities and timeframes, follows up with responsible parties, and ensures ongoing, valuable, and tangible progress on resolution of issues.
• Is a resource to the practices for all charge and collection activities in the offices. This includes troubleshooting system issues, developing practice-specific workflows, testing new functionality or processes, assisting with pricing requests, and developing or interpreting reports.
• Works with CDM team, Finance, Information Systems, and physician billing office on pricing requests and setup of new procedure codes in the system. Ensures appropriate setup for billing and reporting accuracy. Monitors overall CDM process from the requestor perspective to ensure ease and timeliness of process.
• Monitors and analyzes denial logs and reports to identify trends and opportunities. Initiates and implements processes to reduce denials and monitors performance to ensure complete resolution. Performs/maintains projections of financial impact of revenue cycle improvements.
• Provides direct supervision to primary care Coding Support Specialists (CSS), including hiring, orientation, performance management, monitoring continuing education, etc. Provides indirect oversight, education, and coordination of other CSS staff within the MG. Works directly with all CSS staff and their supervisors to provide consistent coverage of work queues, develop/maintain consistent performance standards/expectations, and provide consistent education and support to providers.
• Works with staff to identify trends and issues being seen in the work queues. Identifies opportunities for new edits/flags, smart sets, and other system modifications to reduce charge errors and denials.
• Works with Director of Quality Initiatives, Information Systems, and Coding Compliance to create and maintain smart sets. Educates physicians and staff on how/when to use.
• Initiates provider education on trends/issues being seen in the work queues. Reviews issues and makes clear recommendations for reducing errors. Coordinates further education/action with Coding Compliance and/or Epic Training and ensures follow-though.
• Ensures annual review/update of procedure and diagnosis codes is performed timely and comprehensively. Ensures RVUs, surgical assist, modifier 26 eligibility and other annual updates are performed as well.
• Maintains knowledge of physician coding (CPT-4, ICD-9, HCPCS) and Medicare regulations (LCD, NCD, CCI, etc.).
• Abides by all of the applicable policies, procedures and guidelines of NorthShore and assists in the administration of the Corporate Compliance Plan.
• Ensures that actionable items are resolved in a timely fashion or moved to a higher level within the corporate structure of NorthShore to ensure resolution, including to the Corporate Compliance Officer as appropriate.
• Agrees to prepare and provide aggregate reports for the Corporate Compliance Committee in a timely fashion as requested by the Chief Compliance Officer

What you will need:

• Education: Bachelors Degree Required and Masters Degree Preferred
• Experience: 7+ Years of experience in healthcare billing, operations or coding, preferably in physician practices and 4 Years of years in a management role.
• Certifications: Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA) RHIT
  Required and Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA) RHIA Required and Certified Coding Specialist - Physician based (CCS-P) - American Health Information Management Association (AHIMA) CCS-P Required and Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC) CPC Required
• Skills: Strong project management skills, including the ability to work independently, prioritize, and demonstrate initiative in identifying solutions to problems. Proven ability to successfully lead disparate teams and large projects. Strong verbal and written communication skills. Knowledge of ICD-9, CPT-4 and HCPCS coding systems. General knowledge of physician office operations, with an understanding of Medicare provider-based billing desirable. Intermediate-level proficiency in MS Excel. Ability to perform detailed analysis of problems and data, identify trends and patterns, and recommend and implement large-scale technological or workflow solutions.

Benefits:

• Career Pathways to Promote Professional Growth and Development
• Various Medical, Dental, and Vision options
• Tuition Reimbursement
• Free Parking at designated locations
• Wellness Program Savings Plan
• Health Savings Account Options
• Retirement Options with Company Match
• Paid Time Off
• Community Involvement Opportunities

Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals - Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) - all recognized as Magnet hospitals for nursing excellence. For more information, visit www.endeavorhealth.org.

When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.

Please explore our website (www.endeavorhealth.org) to better understand how Endeavor Health delivers on its mission to "help everyone in our communities be their best".

Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information.

Diversity, equity and inclusion is at the core of who we are; being there for our patients and each other with compassion, respect and empathy. We believe that our strength resides in our differences and in connecting our best to provide community-connected healthcare for all.

EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.

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