Job Description

Pain Specialists of America ("PSA") is a Texas-based, multisite comprehensive pain management company that includes over 15+ locations. We are seeking talented professionals who can support the business and help it achieve its strategic objectives.

The Coding and Insurance AR Manager (“Manager”) and all PSA employees must demonstrate an absolute commitment to excellence, respect, and delivery of the highest quality patient care. The Manager must maintain all technical standards to meet continuous quality improvement and financial and delivery requirements.

Detailed Responsibilities and Essential Functions

• Oversees the daily operations of the coders and authorizations teams, including workload and staffing; hiring, disciplining, and performance appraisals; training; and monitoring quality of work.
• Develops long-range and short-term goals, objectives, plans, and programs and ensures they are implemented.
• Assists in planning, developing, and controlling the budget, including staffing costs, capital equipment, and operations of the coding unit.
• Evaluates the impact of innovations and changes in programs, policies, and procedures for the coding unit. Designs and implements systems and methods to improve data accessibility. Identifies, assesses, and resolves problems. Prepares administrative reports.
• Monitors and maintains acceptable accounts receivables associated with un-coded charts.
• Oversees and monitors the coding compliance program. Develops and coordinates educational and training programs regarding elements of the coding compliance program such as appropriate documentation and accurate coding to all appropriate staff including coding staff, physicians, billing staff, and ancillary departments. Ensures the appropriate dissemination and communication of regulatory, policy, and guideline changes.
• Conducts and oversees coding audit efforts and coordinates monitoring of coding accuracy and documentation adequacy. Reports noncompliance issues detected through auditing and monitoring, the nature of corrective action plans, and the results of follow-up audits to the directors of hospital and the compliance officer.
• Conducts trend analyses to identify patterns and variations in coding practices and case-mix-index. Compares coding and reimbursement profile with national and regional norms to identify variations requiring further investigation.
• Reviews claim denials and rejections pertaining to coding and medical necessity issues and, when necessary, implements corrective action plan (such as educational programs) to prevent similar denials and rejections from recurring.
• Interacts with a variety of people who impact the success of coding compliance program, and functions as a facilitator, liaison, and/or motivator.

Requirements

Qualifications, Abilities, and Skills

· Extensive knowledge of coding principles and guidelines.

· Extensive knowledge of hospital/technical and professional services reimbursement systems.

· Extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, and billing for professional and technical services.

· Strong managerial, leadership, and interpersonal skills.

· Excellent written and oral communication skills.

· Excellent analytical skills.

Education and Experience

· Bachelor’s degree in related field (Preferred but not required)

· Five years of medical coding (in-patient and out-patient) experience required.

· Registered Health Information Administrator certification preferred.

Physical Requirements:

· Prolonged periods of sitting at a desk and working on a computer.

· Must be able to lift up to 15 pounds at times.