Hcc Risk Adjustment Coder Jobs in Philadelphia, PA

Axia Women's Health is the nation’s largest community-based, integrated women's health network in the country serving women throughout New Jersey, Pennsylvania, Indiana, and Kentucky. At its core, Axia Women’s Health is a community of over 400 providers across nearly 150 locations committed to providing a more caring, connected, and progressive health care experience for women.  Its rapidly growing network spans OB/GYN care, breast health, high-risk pregnancy care, urogynecology care, behavioral health, and fertility. Together, Axia Women's Health puts women first by delivering the personalized care needed for women to lead healthier, happier lives. Axia Women’s Health has been recognized as the #1 Physician Practice for Women’s Health by Castle Connolly and certified as a Great Place to Work for five consecutive years. Learn more at www.axiawh.com.

The Director, Coding leads the function of coding/auditing for Axia Women’s Health. The Director is responsible for mapping the policies and processes of coding in compliance with all applicable rules and regulations and the Axia Compliance Program.

Essential Functions:

• Develops and oversees an effective coding function within the organization that provides the ideal service to our providers, ensuring best practices, efficiencies, quality outcomes and maximized revenue.
• Ensures external coding vendor operates efficiently and effectively including staffing, processes and supporting systems.
• Works with Manager of Coding and the Axia Compliance Officer and other coding professionals to design and streamline coding and compliance processes.
• Ensures professional translation and communication of audit findings to educate providers and care centers to ensure compliance with applicable rules/regulations and Axia Compliance Program.
• Communicates and trains care centers on documentation rules and requirements.
• Keeps abreast of CMS rules and guidelines and communicates changes to coding and auditing team.
• Establishes and manages key performance indicator (KPI) reporting for the coding team. Reviews KPIs daily and take an active role in making appropriate adjustments to ensure goals are met.
• Analyzes reports to determine status of outstanding AR, denials, and unbilled claims related to coding operations and works to resolve issues. Identify denial trends to effectively manage future denials
• At the direction of the Axia Compliance Officer, researches and analyzes compliance issues utilizing various publications including extensive use of the internet, the Federal Register and other industry publications.
• Delivers timely reports to leadership, initiates, and communicates the resolution of issues and timely responses to questions and concerns.
• Partners with and maintain positive relationships with internal customers, including physicians, advanced practice providers, care center managers, RCM, regional operations, and third-party coding/billing vendor.
• Analyzes and addresses staff performance and conduct in a timely and professional manner, offering counseling, correction, and discipline as appropriate. Performs periodic reviews to mentor and gives constructive performance feedback.
• Monitors and adheres to applicable Federal, State, and Local laws and regulations, Axia’s Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures. 

Supervisory Responsibilities:

• Oversees coding personnel

Qualities & Skills

• Expert on physician billing with an in-depth knowledge of revenue cycle management process, medical coding, and compliance.
• Firm grasp on coding guidelines and CMS guidelines, rules, and regulations.
• The ability to investigate compliance rules.
• The ability to break down rules and requirements to educate coders, physicians, advanced practice providers and care center personnel.
• Understand Value Based Care and Bundled codes.
• Strong leadership and ability to delegate and provide direction.
• Exceptional verbal, interpersonal, and written communication skills; ability to present ideas in a business-friendly and user-friendly way.
• Computer proficiency, including MS Office and EMRs.

Education & Experience

• Bachelor’s degree or higher preferred or equivalent 8-10 years relevant experience required.
• Minimum 5 years’ experience in billing/coding management.
• CPC through AAPC or CCS-P through AHIMA required.
• Demonstrated excellent Microsoft Excel skills.

The estimated range is the budgeted amount for this position. Final offers are based on various factors, including skill set, experience, location, qualifications and other job-related reasons.

At Axia Women’s Health, we’re passionate about creating a community where our colleagues and patients feel empowered to be their full, authentic selves.  We welcome all individuals – without regards to gender, race, ethnicity, ability, or sexual orientation – and proudly celebrate our individual experiences and differences.

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification form upon hire.  Applicants must be currently authorized to work in the United States on a full-time basis.