Director, Professional Coding Auditing Services

Director, Professional Coding Auditing Services in NASHVILLE, TN

Ardent Health Services (AHS) is a national healthcare company headquartered in Nashville, TN. Our subsidiaries own and operate hospitals and multispecialty physician practices in six states. Ardent includes 20 hospitals, 3,200 patient beds, 18,000 employees, and 475 employed physicians. Within the industry, we are noted for recognizing that every hospital is as unique as the community it serves. This in-depth understanding of how health care works at the local level is one of our great strengths.

We have an exciting opportunity to join our Legal team as the Director, Professional Coding Audit Services.

The Director Professional Coding Audit Services reports to the Chief Compliance Officer and lead a team of five. This position provides leadership for auditing the efficient and accurate submission of all inpatient and outpatient professional coding across the clinical enterprise. Through audits and education, the Director ensures that assigned professional services codes and charges accurately reflect the diagnoses, procedures and services performed and supported by documentation. This position is responsible for establishing an audit schedule of employed physician and mid-level provider services that addresses opportunities for improvement. The Director ensures that provider education takes place timely and in support of audit findings and works to reinforce documentation improvement opportunities. The Director partners with Physician Practice Management, HIM, and Clinical Documentation Improvement teams as well as Medical Staff and other leaders to ensure alignment with organizational objectives to meet regulatory, reimbursement, documentation improvement and data integrity goals. The position serves as a resource to other departments and clinics as related to professional services coding quality, auditing, education and appropriate reimbursement.

RESPONSIBILITIES:

  • Assumes responsibility for achievement of coding best practices and enterprise-identified coding metrics and regularly achieves established compliance goals, providing justification and corrective action when goals are not met.
  • Develops and directs implementation of best practice coding for all professional practice groups. Identifies and implements changes that enhance effectiveness of coding practices, and ensure compliance with regulatory standards.
  • Maintains the professional services audit schedule and methodology to ensure timely and cost-effective audits. Ensures distribution of audit reports and metrics to senior leadership.
  • Engages physicians and mid-level providers in a consistent and documented communication loop to include real-time feedback regarding errors and improvement opportunities.
  • Exhibits strong working knowledge of current federal and state regulations and requirements and integrates requirements into coding audits, education and follow up.
  • Develops and maintains professional services coding and documentation policies. Ensures audits of policy compliance.
  • Works with Physician Practice Management team to minimize professional coding denials, monitor and report on impact of professional coding denials, and identify and plan content regarding physician education initiatives.
  • Works with Revenue Cycle team to establish checks and balances to ensure all services are captured, coded and submitted timely and accurately.
  • Assures appropriate knowledge of coding audit staff based on credentialing, education, and results of internal quality reviews. Works with coding audit staff to provide education and corrective action as needed.

QUALIFICATIONS:

Ability and willingness to travel 40% to 60%.

Education:

  • Bachelor's degree required in health related field
  • CCS, CPC, or other coding/HIM credential required
  • ICD10 training certified


Experience:

  • Excellent written and verbal communication skills, including the ability to present ideas and concepts effectively to physicians, employees and leadership.
  • Minimum of five years of experience in professional fee coding and 3 years of management, preferably with a large multi-specialty physician practice.
  • Strong analytical skills, systematic and orderly planning abilities, and high attention to details.
  • Advanced level coding skills in ICD-9-CM/ICD-10-CM, HCPCS/CPT.
  • Exceptional project management and organizational skills, with the demonstrated ability to drive multiple concurrent projects to completion in a complex, consensus-oriented environment.
  • NextGen and Epic experience preferred.