This posting shall remain open until filled.
UCSD Layoff from Career Appointment: Apply by 11/03/2016 for consideration with preference for rehire. All layoff applicants should contact their Employment Advisor. Eligible Disability Counseling and Consulting services (DCC) or Special Selection clients should contact their Vocational Rehabilitation Counselor for assistance.
Reporting to the Director, Corporate Compliance and indirectly to the Chief Compliance, Privacy and Risk Officer, the Hospital Billing Compliance Manager is charged to ensure UC San Diego (UCSD) Health's commitment to compliance by implementing the annual coding compliance work-plan, and maintaining current coding compliance training curriculum materials related to hospital coding and documentation for UCSD Health's clinical services. The manager is responsible for ongoing quality review and assessment of coded hospital data. Performs audits on the accuracy of ICD-9, ICD-10, CPT-4, MS-DRG, APR-DRG and APC assignments. Prepares reports for management review and identifies trends. Conducts focused retrospective and pre-bill audits.
Responsible for communicating UCSD Health's coding compliance standards and procedures, and for providing guidance and clarification related to coding questions to support accurate billing – to employees and to authorized representatives of UCSD Health's billing agents. Participates and leads in developing policies and procedures for the clinical enterprise and the compliance program in support of accurate and efficient coding and billing. Provides audit liaison services, as requested. Responsible for monitoring billing, coding and related claims submission changes and updates from the Center for Medicare and Medicaid Services (CMS), Medicare Administrative Contractor (MAC), Beneficiary and Family-Centered Care (BFCC) QIO, Medi-Cal and other related government entities.
Incumbent is responsible for ensuring audits initiated by the Center for Medicare and Medicaid Services (CMS), the Office of Inspector General for the Department of Health and Human Services (OIG), Medicare Administrative Contractor (MAC), Beneficiary and Family-Centered Care (BFCC) QIO, Medi-Cal and other related government entities are responded to timely and thoroughly. The position is responsible for developing and communicating a comprehensive corrective action plan to any identified opportunities for process improvement. Support day-to-day operations for unit and provide work directions to lower level staff as needed. Job standards are to be performed at the EXPERT level.
Six (6) years of recent experience in coding and auditing hospital claims for hospital billing.
Recent experience as an educator of medical coding and documentation.
A Bachelor's Degree in relevant field; or equivalent combination of education and experience.
Coding certifications (at least one or more), such as: CPC-H, CCS, CCA; and/or Advanced training: RHIT, RHIA, RN, or equivalent degree.
Proven in-depth knowledge and ability to comprehensively review patient records for medical documentation of CPT4, ICD9, ICD10 coding and DRG assignment.
Ability to review, interpret and explain regulatory bulletins and technical coding information in a clear and effective manner.
Proficient computer skills (e.g., MS-Office, Excel, Power Point, Publisher).
Demonstrated ability to provide training to others.
Ability to produce, present and interpret detailed billing activity reports.
Effective interpersonal and communication skills (oral and written); proficiency in preparing communication materials.
- Certified ICD-10 proficient or certified ICD-10 trainer.
- Proven proficiency in using Epic E.H.R. and other information systems.
Must be able to work various hours and locations based on business needs.