As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
Conifer Compliance maintains and oversees a compliance program that is consistent with the HHS Office of Inspector Generalï¿½s Compliance Program Guidance for Third Party Medical Billing Companies (ï¿½Guidanceï¿½), which is built around the seven fundamental elements described in the Guidance. The Director of Coding Compliance & Quality (ProFee) serves as the risk champion over coding accuracy, quality and audit and establishes and implements leading compliance practices to prevent fraud waste and abuse within Coniferï¿½s Coding and CDI functions for the Physician Revenue Cycle Management (PRCM) business unit.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Provides client support and strategic leadership for the PRCM coding compliance & quality functions.
Provides oversight, monitoring, investigation, and resolution of compliance issues relating to coding and reimbursement, health records and documentation, and quality data for all PRCM clients; is responsible for developing, implementing, and maintaining a coding education program for Conifer as it relates to coding and documentation requirements for accurate coding.
Serves as a subject matter expert and resource for information and clarification on accurate and ethical coding and auditing processes and demonstrates a thorough knowledge of coding guidelines, governmental regulations, and third party billing requirements and is able to compare/contrast the guidelines/rules/regulations in order to discern which apply to the audit being performed. Interprets the often complex clinical content of a patient record including the most complicated medical diagnoses and surgical procedures.
Maintains an effective coding compliance program with applicable federal and state regulations and validate and resolve non-compliance issues with appropriate corrective actions
Works collaboratively with Compliance Monitoring & Oversight, Third Party Oversight, other Compliance functions and Coding Operations to ensure that the coding quality of all Conifer third-party vendors meets or exceeds quality standards, interfaces directly with internal and external clients for reporting responsibilities, prepares all necessary periodic reporting for clients and Conifer governing bodies, ensures compliance with the Guidance is being upheld in every respect regarding billing, coding and claims submission, conducts annual risk assessments, and serves as co-chair of the Conifer Senior Leadership Risk Working Group and reports regularly to the Conifer Executive Risk Steering Committee and/or the Board of Managers as needed.
Develop and implement, at the direction of the Chief Compliance Officer, any programs, systems or processes needed to improve or revise the PRCM coding compliance program.
Strong leadership and communication skills, problem solving abilities; good knowledge of medical records systems
Ability to build and maintain teamï¿½s dynamics
Serve as a resource to Conifer and client contacts
Advanced knowledge of ICD-9-CM, ICD-10-CM/PCS, and CPT coding principles and rules
Advanced knowledge of disease pathophysiology and drug utilization
Advanced knowledge of MS-DRG & APR-DRG classification and reimbursement structures
Advanced knowledge of APC, OCE, NCCI classification and reimbursement structures
Advanced knowledge of the functions of hospitals, medical clinics, and third-party medical companies
Keeps abreast of new technology in coding and abstracting software and other forms of automation and stays informed about transaction code sets, HIPAA requirements and other future issues impacting the coding function
Ability to work under deadlines and juggle multiple projects
Ability to work independently and as part of a team
Ability to multitask with flexibility of daily priorities
EDUCATION / EXPERIENCE
Ten (10) years of recent experience in relevant coding or coding staffing leadership work in the field
Five (5) years of previous relevant management experience related to coding and auditing functions.
Demonstrated coding and audit experience.
Experience ICD-9-CM, ICD-10-CM/PCS, CPT, HCPCS, and CDI
Bachelor degree in Health Information Management /Technology and AHIMA credentials required; Masters Degree preferred
CERTIFICATES, LICENSES, REGISTRATIONS
Required: Current RHIA or RHIT AND CCS credential
AHIMA ICD-10-CM/PCS Trainer preferred
Must be able to efficiently use computer keyboard and mouse to perform coding assignments
The ideal candidate will have coding management experience in an acute care facility
Must be able to travel nationally up to 25% - Duties may require travel via plane, car, train, bus, taxi-cab, etc.
Job: Conifer Health Solutions
Primary Location: Frisco, Texas
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Internal Number: 2005018103
About Conifer Health Solutions
“Tenet Healthcare Corporation is a diversified healthcare services company with 115,000 employees united around a common mission: to help people live happier, healthier lives. Through its subsidiaries, partnerships and joint ventures, including United Surgical Partners International, the Company operates general acute care and specialty hospitals, ambulatory surgery centers, urgent care centers and other outpatient facilities. Tenet's Conifer Health Solutions subsidiary provides technology-enabled performance improvement and health management solutions to hospitals, health systems, integrated delivery networks, physician groups, self-insured organizations and health plans.