Remote - Senior Manager Ops Consulting (Local to Birmingham, AL)

Overview

Guidehouse is a leading global provider of consulting services to the public sector and commercial markets, with broad capabilities in management, technology, and risk consulting. By combining our public and private sector expertise, we help clients address their most complex challenges and navigate significant regulatory pressures focusing on transformational change, business resiliency, and technology-driven innovation. Across a range of advisory, consulting, outsourcing, and digital services, we create scalable, innovative solutions that help our clients outwit complexity and position them for future growth and success. The company has more than 12,000 professionals in over 50 locations globally. Guidehouse is a Veritas Capital portfolio company, led by seasoned professionals with proven and diverse expertise in traditional and emerging technologies, markets, and agenda-setting issues driving national and global economies. For more information, please visit www.guidehouse.com.

Responsibilities

Summary: Remote (must live within a commutable distance to Birmingham, AL)

Under general supervision, to assist with analysis of coding denials, edit review, and coding education. Lead coding team in complaint manor maintaining current knowledge of payer rules and regulations, code updates and carrier policy changes. Communicate updated to providers and management teams impacted by these changes. Applicant should feel comfortable with creating and presenting information in person or via Zoom or Teams Meetings in presentation format. Participation in revenue cycle management meetings will be required. Initial presence for training will be gaged by assignments. Eventually, this will only require one day per week on-site and four days can be remote work. Occasional project may require on-site meetings outside of the routine remote work schedule.

Responsibilities

• Collaborate with providers, clinical management and clinical associates to improve the overall quality and effectiveness related to accurate and complete charge capture.
• Perform in depth analysis of current billing and coding activity.
• Perform reviews of documentation as it related to correct coding, both services performed and diagnosis selection.
• Provide feedback, supporting documentation and suggestions or assistance in implementing accurate and efficient charge capture.
• Engaged participation will be required in project management activities for assigned new initiatives within the MSO, Health Services Foundation and Health System.
• Act as a liaison to providers, clinical associates, and clinical departments related to coding initiatives, changes, coding and billing updates.
• Assist department liaisons with coding and compliance issues and attend departmental meetings as requested. Serve as a coding education resource for department leaders and/or providers.
• Participate in weekly Workflow 10 meetings, to manage and complete billing data in the SharePoint spreadsheets for code additions to Playbooks and Cerner Medications requested by the providers and clinical managers by validating codes, descriptions and necessary code logic.
• Research new procedure requests for departments and Workflow 10 Clinical Informatics representatives and provide education on billing requirements.
• Coordinate charge capture activities, when appropriate, with hospital HIM/CDM group to ensure all coding processes and systems maintained are in sync for submission of procedure codes.
• Assist with charge capture testing review as requested.
• Maintain thorough knowledge of compliance requirements and regulations.
• Stay abreast of coding updates and disseminate information to appropriate parties and management.
• Monitor published coding and reimbursement changes made by carriers and communicate changes to coding leadership/teams.
• Participate in MSO Monthly Compliance Meetings and complete education and assignments as delegated.
• Participate in Physician and Revenue Cycle Leadership Meetings and provide slides that update leadership on new billing processes or requirements and process improvement opportunities.
• Participate in Payer Representative on-site meetings (Blue Cross and Palmetto) and take learned regulations and billing information back to appropriate providers, clinical associates, MSO associates and/or management.
• Complete analysis of coding denials for coding and payer guideline education to coding teams and/or providers. Assist Third-Party follow-up teams with charge corrections and appeals.
• Attend Aviacode (and other outside vendor) meetings for progress reporting. Review impact of Aviacode or other vendors coding on system edits and work burden for the coding department. Assist leadership with process improvement plans to decrease edits.
• Conduct periodic TES edit review for updates or removal as indicated by coding updates.
• Assist MSO associates with billing research and provider communications when services and documentation require clarification and/or corrections.
• Request coding corrections for HSF and hospital charges based on medical record documentation and coding requirements (payer policies, LCD s, etc.).
• Review paper charge tickets for coding updates annually (Diagnosis, CPT and HCPCS) and provide deleted and new code updated to IT department for changes prior to effective dates.
• Complete presentations related to education sessions assigned or identified as necessary. Participate in management meetings to include creation of slides to communicate assigned education or analysis reporting.
• problems to departments and/or liaisons when necessary
  

Qualifications

Education and Experience:

• Required: Bachelor s Degree in related field such as Finance, Accounting, Nursing and Health Care Administration with a minimum of 10 years of experience in in coding or revenue cycle management.
• Preferred: Master s Degree in related field such as Finance, Accounting, Nursing and Health Care Administration.
• Required: Must live in Birmingham, AL or surrounding areas to be REMOTE.
  

License, Certification And/or Registrations

• Required: One of the following certifications/licenses
• Certified Professional Coder (CPC), or Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS), or Registered Nurse (RN), or Certified Public Accountant (CPA).
  

Ethics And Compliance

Employee performs within the prescribed limits of the company s and client s Ethics and Compliance program and is responsible to detect, observe and report compliance variances to their immediate supervisor, or upward through the chain of command, the Compliance Officer, or the Revenue Integrity Office.

Employee completes all required annual compliance education.

Additional Requirements

The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.

Disclaimer

About Guidehouse

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [email protected]. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

Rewards And Benefits

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits Include

• Medical, Rx, Dental & Vision Insurance
• Personal and Family Sick Time & Company Paid Holidays
• Position may be eligible for a discretionary variable incentive bonus
• Parental Leave and Adoption Assistance
• 401(k) Retirement Plan
• Basic Life & Supplemental Life
• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
• Short-Term & Long-Term Disability
• Tuition Reimbursement, Personal Development & Learning Opportunities
• Skills Development & Certifications
• Employee Referral Program
• Corporate Sponsored Events & Community Outreach
• Emergency Back-Up Childcare Program