Coding Integrity Specialist Jobs in Nevada (NOW HIRING)

The VRM Pro-fee Manager is responsible for assisting in the development and evolution of the overall strategy for the Company’s Vendor Resource Management for pro-fee coding operations.  The VRM Pro-Fee Manager manages, directs and coordinates the pro-fee coding activities for the Vendors in collaboration with the Central Coding Unit (CCU). The VRM Pro-Fee Manager plans, assigns and directs the coding workflow between Vendors and CCU; actively monitors employee and vendor performance; addresses complaints and resolves problems; and actively monitors production and quality control efforts. The VRM Pro-Fee Manager is responsible for preparing/monitoring forecast volumes and scheduling/coordination/queue monitoring of production coding resources to assure accounts available for coding are coded within Service Level Agreement (SLA).  The VRM Pro-Fee Manager ensures Vendor inventory is monitored daily; ensures queue concerns or resource changes are communicated to CCU as needed; ensures coder productivity and daily/weekly/monthly completion volumes are tracked and monitored. The VRM Pro-Fee Manager is expected to interact with CCU Leadership as well as VRM leadership for overall collaboration in regard to Vendor activities. The VRM Pro-Fee Manager is also actively engaged in continuous process improvement activities to enhance timely claims completion, financial performance, and corporate contribution.   

What you will do in this role: 

• Provides direct managerial oversight to vendors and Team Leads in management of profee coding functions, work queues, work processes, and overall work responsibilities.  
• Ensures complete, accurate, timely and consistent coding, while adhering to published coding guidelines and Company policies  
• Coaches and helps develop team members; helps resolve dysfunctional disruptive behavior and promotes teamwork within functional area(s); disciplines and counsel staff as necessary  
• Proactively manages (including corresponding communications and escalation paths) significant issues in coding, status of projects, barriers and successes  
• Selects, evaluates, trains, and provides leadership and direction to reporting staff  
• Responsible for continuous review and improvement of processes and services  
• Responsible for ensuring employee work schedules sufficiently meet business and customer needs  
• Provides guidance and oversight in retrieving, organizing and reporting data  
• Facilitates problem solving and collaboration within functional area(s)  
• Works closely with other members of the Parallon Central Coding Leadership Team in addressing issues impacting accurate/timely coding and documentation  
• Responsible for ensuring staff/vendor coding personnel compliance with documented and established workflow guidelines as it relates to adding and re-assigning accounts to work queues/worklists  
• Facilitates the resolution of IT issues as it relates to vendor workflow; submits break fix requests for any reports used by coding vendors or VRM team  
• Monitors quarterly quality scores by vendor and specialty and requesting action plans from the vendors accordingly Assists in identifying and implementing process improvements to decrease costs and improve service for applicable stakeholders  
• Performs productivity monitoring and provides timely and consistent feedback to vendor and VRM pro-fee team leads  
• Monitors, escalates and assists in the resolution of system issues reported by the production coders  
• Manages tracking of vendor staff and turnover  
• Manages all month end processes, including but not limited to, ensuring month end volumes are pulled and sent to the vendors, month end turnover and volumes are sent to leadership, and month end related inventory issues are escalated to CCU Leadership for resolution.  
• Monitors vendor coders pended accounts in production to ensure timely turnaround per contract agreement  
• Provides timely follow-up to customer escalations related to coding quality and coding process issues  
• Responds to customer requests for action plans to improve coding quality and operational process concerns  
• Promptly reports issues or trends to the appropriate member of the Parallon Leadership team, or other appropriate party  
• Reviews all official data quality standards, coding guidelines, company policies and procedures, and clinical/medical resources to assure coding knowledge and certification remains current  
• Prepares and hosts weekly and/or ad hoc vendor conference calls  
• Coordinates work assignments to achieve operational goals  
• Manages the onboarding process for VRM support staff  
• Establishes and maintains good working relationships with the vendors and Parallon stakeholders  
• Coordinates and ensures completion of training and education for VRM team leads and vendor coders  
• Works with multi-disciplinary teams in addressing issues related to coding and medical record improvement (as applicable)  
• Participates in weekly rotation of on call coverage of IT&S issues and facilitates escalations as necessary  
• Ensures safe, ergonomic, and confidentiality compliant practices are being followed within the work environment  

• Except where otherwise indicated, all responsibilities outlined above are applicable to both Professional Fee (ProFee) and Hospital Outpatient Facility coding operations.

• Maintains advanced knowledge of Hospital Outpatient Facility coding guidelines, regulatory requirements, reimbursement methodologies, and operational workflows to effectively support vendor oversight, operational decision-making, and process improvement initiatives.
• Analyzes quality data to identify education opportunities; provides education suggestions to Parallon HIM corporate quality team when applicable 
• Provides operational oversight of vendor Outpatient CPART review activities, assists in resolving workflow and operational issues, and escalates concerns as appropriate to support timely account completion.
• Monitors vendor coders pended accounts in production as well as in HIM CPART review tool to ensure timely turnaround and proper holds per contract agreement
• Monitors vendor eRequest work queues for Hospital Outpatient Facility coding, assists in resolving coding and workflow issues, and escalates operational concerns as needed to ensure timely account completion and compliance with established workflows.
• Provides operational oversight of vendor Outpatient CPART review activities, assists in resolving workflow and operational issues, and escalates concerns as appropriate to support timely account completion.
• Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”  
• Other duties as assigned 

Qualifications: 

• Undergraduate degree required. Bachelor’s degree strongly preferred. Equivalent work experience may substitute education requirements  
• Inpatient/outpatient professional fee coding experience preferred 
• Minimum three years’ experience in related area preferred with two of these years being healthcare management experience  
• Experience managing multi-specialty coders is strongly preferred. 
• RHIA, RHIT and/or CCS/CPC required