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Clinical Operations Manager - Medical Coding

Company: Multiplan
Location: Newtown Square
Posted on: January 14, 2018

Job Description:

Job DescriptionJOB SUMMARY: This position is responsible for managing all facets of the Clinical Operations team including education, staffing, product evaluation and enhancement, and policies/procedures to ensure smooth and efficient operations.JOB ROLES AND RESPONSIBILITIES:

  • Manage the day-to-day Clinical Operations' team including but not limited to the monitoring of individual and staff workload, operational productivity and performance, training, mentoring, motivating and management of workflows.
  • Manage high priority claims and escalations as well as manage and track assigned department workload re-distributing as necessary.
  • Provide instructions and direction to staff on individual escalated cases.
  • Provide expert guidance and support to clinical team members; serving as Subject matter Expert(SME)
  • Effectively collaborate, coordinate and communicate across various disciplines and departments throughout the organization to resolve problems and ensure consistency and accuracy.
  • Manage departmental performance to establish, meet, maintain and monitor metrics within turnaround time limits.
  • Identify issues, problems, and opportunities, bring suggestions, and implement solutions to improve department's effectiveness and efficiency
  • Complete and oversee all quality audit reviews, including rebuttal processes and escalations.
  • Complete and oversee special projects assigned by leadership.
  • Create and distribute goals and standards to staff regularly.
  • Participate in the development of policies and procedures based on current and future trends.
  • Select, develop, and evaluate staff to ensure the efficient operation of department.
  • Collaborate, coordinate, and communicate across disciplines and departments.
  • Ensure compliance with HIPAA regulations and requirements.
  • Demonstrate Company's Core Competencies and values held within.
  • Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.JOB SCOPE:The incumbent works independently and exercises significant independent judgment. The incumbent will manage staff and help provide thorough and appropriate responses to meet the goals of the department. The incumbent provides input to make critical business decisions, including staffing and process improvement, and impacts day-to-day operations through the oversight of coding reviews and providing direction to staff on individual cases. This is a people management job with authority for all HR actions (hiring, separations, discipline, training, etc.).JOB REQUIREMENTS (Education, Experience, and Training):
    • Minimum Bachelor's degree in healthcare, business, or related field preferred
    • Minimum 7 years' experience in the healthcare industry with a minimum of 4 years in a leadership role with people management responsibilities
    • Minimum 2 years' experience as a manager of clinical staff preferred
    • Previous coding experience of minimum 2 years
    • Experience with complex hospital and medical billing procedures and coding
    • Required licensures, professional certifications, and/or Board certifications as applicable - Certified by the American Health Information Management Association in coding (CCA, CCS, RHIA, RHIT) or the American Academy of Professional Coders (CPC, CPC-P, CPC-H)
    • Knowledge of medical coding systems (i.e., CPT, ICD-9/10, revenue codes)
    • Knowledge of Worker's Comp, Auto Medicare and Government sponsored programs (such as Medicare or Medicaid)
    • Knowledge of provider billing and collection practices
    • Teaching, mentoring and presentation skills and experience
    • Communication (verbal, written and listening), managerial, interpersonal, organizational, time management, problem solving and leadership skills.
    • Ability to commit to providing a level of customer service within established standards
    • Ability to analyze data and arrive at a logical conclusion
    • Ability to identify issues and determine appropriate course of action for resolution
    • Ability to display professionalism by having a positive demeanor, proper telephone/email etiquette and using proper language and tone.
    • Ability to elicit trust and credibility with all levels of the organization
    • Ability to use software and hardware related to job responsibilities, including MS Office Suite, online coding tools, and database software.Company DescriptionMultiPlan helps healthcare payers manage the cost of care, improve competitiveness and inspire positive change. We use sophisticated technology, data analytics and a team with deep industry experience to interpret the needs of our clients, and then we develop innovative solutions to meet those needs by combining and tailoring our payment integrity, network-based, and analytics-based services.

      Keywords: Multiplan, Philadelphia, Clinical Operations Manager - Medical Coding, Healthcare, Newtown Square, Pennsylvania

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