Senior Manager, Provider Education & Auditing
Steward Health Care System LLC ("Steward") is a fully integrated, physician-led national health care services organization committed to providing the highest quality of care in the most cost-efficient manner in the communities where out patients live. Steward - the largest privately held health care company in the U.S. - owns and operates 35 community hospitals across nine states, serves over 1,000 distinct communities and employs approximately 40,000 health care professionals. In addition to our hospitals, the Steward provider network includes 4,800 providers, 25 urgent care centers, 87 preferred skilled nursing facilities, substantial behavioral health offerings, over 7,300 hospital beds under management, and approximately 1.5 million full risk covered lies through the company's managed care and health insurance services.
Steward Medical Group (SMG), Inc. is Steward's multi-specialty group practice with over 4,500 employees including over 1,800 physicians and advanced practitioners. SMG operates approximately 450 practice locations throughout Massachusetts, Southern New Hampshire, Rhode Island, New Jersey, Pennsylvania, Ohio, Florida, Utah, Arizona, Texas, Louisiana and Arkansas, and provides more than 4 million patient encounters per year.
The Senior Manager, Provider Education & Auditing manages the team responsible for leading CPT assignment training for newly onboarded physicians and mid-level providers across all Steward Medical Group markets. The activities performed by this team include: auditing new providers as described per SMG policy, educating/re-educating coding staff and providers as necessary, reviewing and validating various charges generated by providers, and participating in facility committees and ad hoc meetings as requested. The Senior Manager is the leader of the team and expected to perform in accordance with all policies and procedures, follow standards for ethical business conduct, and serve as a positive role model for the team. This position will report to directly to the Director of Revenue Integrity, who oversees all coding and compliance functions.
- Lead daily operations of the Education & Auditing function and staff, including monitoring the quality and quantity of workflow to ensure the completion of work assignments.
- Provide oversight for coding, documentation, and billing audits, including summarizing audit findings and proposing recommendations. Oversee implementation of audit recommendations as appropriate. Perform follow-up audits and reviews to monitor and validate ongoing compliance with applicable rules and guidelines.
- Educate practices/providers on basic coding, documentation, and billing issues related to appropriately entering charges and documenting the services delivered in compliance with applicable rules and regulations.
- Coordinate and direct internal staff and external coding resources in order to meet specific objectives and timelines for coding activities.
- Educate key stakeholders on significant matters related to coverage decisions, coding issues, and new or revised regulations.
- Maintain excellent intradepartmental communication and build/maintain relationships with Practice Management and other departments and employees throughout Steward.
- Based on experience and industry knowledge, make recommendations to streamline processes related to accurate and appropriate revenue capture for services performed, ensuring compliance with all appropriate regulations and guidelines.
- Identify and implement improvement measures that will enhance department operations and customer service.
- Complete required continuous training and education, including department specific requirements.
- Maintain certifications and stay current on industry trends.
- Design and implement work flow processes to support continuous improvement.
- Provide cost effective management of resources for the Training and Auditing team.
- Monitor and report all required performance measures to include the development of department goals and assist in the assessment of goal attainment.
- Conduct and recommend trainings to improve team performance.
- Resolve any employee personnel issues by following SMG's HR policies, including escalating issues as required.
- Bachelor's degree
- 10+ years coding experience, 5+ years of management experience
- Advanced experience utilizing Microsoft Excel, including Pivot tables
- Beginner/Intermediate experience with Microsoft Access preferred
- Thorough knowledge of health care operations, physician practice reimbursement (including RVUs), charging practices, governmental coding requirements (including extensive knowledge of CPT/HCPCS/ICD and modifiers), and healthcare financial systems
- Experience in researching, interpreting, and applying Medicare, Medicaid, MASSHEALTH, and other third-party payer regulations is essential.
- Excellent problem-solving ability, as well as analytical, communication, leadership, initiative, and management skills are a necessity
- Current certification as a CPC or CCS-P is required
- Certification in Health Care Compliance (CHC) highly desired
Job Status: Full Time
Job Reference #: I44325