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The Director of Physician Coding Compliance is responsible for planning, organizing and directing the operation, training, quality, support services and administration of the Physician Coding Compliance function and resources within the Office of Corporate Compliance to conduct physician coding audits and investigations in a timely manner to meet company and regulatory standards. The Director provides guidance to appropriate personnel for both HealthTexas Provider Network (HTPN) and the Scott & White Clinic to meet both the needs of those entities and the Office of Corporate Compliance to comply with state and federal requirements and CMS guidelines. Develops and implements policy and procedures; updates departments to improve compliance and efficiency. Assists in the development of programs to improve physician documentation, promote compliance and prevent revenue loss. Serves as a professional fee resource for the organization.
WHAT IS EXPECTED (Essential Functions):
Under the direction of the Vice President, Corporate Compliance, actively manages physician coding compliance operations for Baylor Scott & White Health to promote compliance with Federal, state and professional requirements for physician documentation, coding and billing standards.
Responsible for interviewing and selecting assigned staff positions for HTPN Physician Coding Compliance. Monitors and maintains HTPN Physician Coding Compliance staff productivity. Performs training, management, evaluation and counseling of assigned staff, including disciplinary actions up to termination when needed.
Manages a coordinated physician compliance program for Baylor Scott & White Health. Actively participates as a compliance resource and consultant for physicians, mid-level providers, practice administrators and other physician practice staff. Works to resolve compliance issues timely and facilitates communication of compliance related matters. Serves as focal point for internal and external physician coding compliance activities.
Identifies process improvement opportunities for Physician Coding Compliance to achieve high quality outcomes in physician CPT and ICD-10 coding, documentation and billing.
Oversee the development, implementation, dissemination, and adherence to policy and procedures related to physician coding, documentation and billing activities.
Develop, implement and monitor coding and documentation education/training program for physicians, mid-level providers and clinic staff to promote Federal and state regulatory compliance, as well as physician coding and documentation compliance.
Develop and present Physician Coding Compliance progress and summary reports or presentations to physicians and executive leadership.
Serve as subject matter expert on accurate and appropriate physician coding and documentation standards, guidelines and regulatory requirements.
Promote consistency in the physician coding audit and education processes between HealthTexas Provider Network and the Scott & White Clinic.
Develops an annual physician coding compliance work plan that addresses physician coding compliance issues and areas of risk.
Manages curriculum development and strategic delivery used to educate physicians and other clinical staff in compliance and coding. Identifies appropriate resource materials used to enable physicians and staff to comply with compliance and coding requirements.
Develops and maintains Baylor Scott & White Health physician coding compliance policies and procedures. Periodically reviews, updates and adds policies and procedures as needed with the approval of the BSWH Corporate Compliance Committee.
Develop, implement and directly oversee audits and investigations of professional fee diagnosis, procedure coding, E/M leveling and charge entry for HealthTexas Provider Network and Scott & White Clinic providers.
Develops programs and models to support document driven, compliant physician coding based on external regulatory and accreditation requirements as well as internal policies, procedures and coding guidelines.
Responds to government investigations of physician coding compliance through coordination with Baylor Scott & White Health Legal department.
Serves as a role-model by adhering to the Baylor Scott & White Health Code of Conduct.
KNOWLEDGE, SKILLS, and ABILITIES:
Minimum of seven (7) years of professional fee/outpatient clinic coding experience in a university, teaching hospital setting.
Advanced knowledge of CPT, E/M leveling, and ICD-10 outpatient coding requirements and CMS regulations required.
Outstanding interpersonal and communication (oral and written) skills required for educational efforts and interdepartmental collaboration.
Maintains working knowledge of Federal, state, private payer and other applicable legal and regulatory requirements related to physician coding compliance.
Strong knowledge of ICD-10 coding processes with excellent analytical skills required.
Ability to effectively manage projects, plan and implement programs and evaluate outcomes required.
Maintain professional competency through continuing professional education, staying abreast of coding and regulatory changes.
Exhibits effective organizational skills, time management, management of multiple priorities and strong project management skills.
Expert in Microsoft Office applications (Word, Excel, Power Point, Access).
Ability to make effective and persuasive presentations on complex topics to upper management and physicians.
Ability to interpret federal and state regulations as they relate to coding and compliance.
Ability to travel throughout North and Central Texas.
Bachelor's degree required
7 plus year's experience required
Certified Professional Coder (CPC) required
RHIA, RHIT preferred
Certificate in Health Care Compliance required or complete within first year
Baylor Scott & White Health (BSWH) is the largest not-for-profit health care system in Texas and one of the largest in the United States. With a commitment to and a track record of innovation, collaboration, integrity and compassion for the patient, BSWH stands to be one of the nation’s exemplary health care organizations. Our mission is to serve all people by providing personalized health and wellness through exemplary care, education and research as a Christian ministry of healing. Joining our team is not just accepting a job, it’s accepting a calling!