Medical Coding Manager – Profee Coding, HealthCare

DESCRIPTION

The Finance Operations organization works with every part of Amazon to provide operations accounting and operations excellence services with the highest level of controllership at the lowest cost to the company. We provide the backbone systems and operational processes that completely, accurately, and validly pay Amazon’s suppliers, invoice our customers, and report financial results. Amazon is quickly building the finance operations capabilities in the healthcare industry by creating the Healthcare Finance Operations Services.

As part of the Amazon Healthcare Finance Operations team, you will find yourself working with exceptionally talented and determined people committed to driving financial improvement, scalability, and process excellence. To support the growth of Amazon Healthcare, this candidate must possess a strong passion for accountability, setting high standards, raising the bar, and driving results through constant focus on improving existing and future state operations, systems, and processes in collaboration with senior management. As the coding manager, you will have oversight of the people, processes, and technology functions for coding operations.

The ideal candidate will have prior leadership experience in revenue cycle management and operations, with much emphasis on medical coding. You are experienced in ensuring compliance with applicable regulations and developing mechanisms for operational adherence to these policies.

This is both a strategic and a hands-on role that requires strong leadership skills, a high degree of organization, strong written and verbal communication, and a passion for collaboration in the design of data-driven programs that optimize reimbursement and revenue, with a focus on the shared services functions. The manager will have a deep knowledge of the healthcare industry or a willingness to learn.

This position is office-based in Pasay City.

Key job responsibilities

• Manage multiple coding-related projects while ensuring team performance meets One Medical’s quality standards and turnaround times are acceptable.
• Stay current with CPT, ICD-10-CM, HCPCS coding guidelines, AHA Coding Clinic guidance, and CMS Risk Adjustment guidance.
• Lead the team in effectively assigning appropriate ICD-10-CM, CPT, HCPCS and other relevant coding elements to office visits, procedures, and diagnoses in a production environment.
• Organize and coordinate the daily operations of the Healthcare Finance Operations Services for the One Medical Coding Team, in collaboration with the Sr. Manager, Healthcare FinOps, to ensure consistent quality, compliance, productivity, and efficiency.
• Coordinate and oversee operational functions, including audits, staffing, performance evaluations, staff development and training, regulatory compliance, coding policies and procedures, and monitoring coding quality and productivity.
• Collaborate cross-functionally to develop comprehensive insights into data drivers and present findings clearly and concisely.
• Participate in collaborative work sessions and projects to clarify processes and guidelines related to Revenue Cycle Operations.
• Track and monitor key revenue cycle performance indicators, and report significant findings to relevant leadership and stakeholders across the organization.
• Engage in initiatives involving technical workflows and the utilization of software solutions.
• Work with partners to develop and implement plans for the operational infrastructure of systems, processes, training, and personnel, aiming to standardize practices and support rapid growth.

BASIC QUALIFICATIONS

Basic Qualifications

• Bachelor’s degree in a relevant field such as healthcare, business, and/or finance.
• Minimum of 3 years of successful team leadership experience, including direct management of staff.
• CPC certification through AAPC and/or CCS certification through AHIMA is required.
• At least 3 years of experience leading a team responsible for outpatient and/or risk adjustment coding.
• Knowledgeable in health systems operations, including reimbursement methodologies and coding conventions.
• Demonstrates the ability to perform accurate and complete chart reviews for HCC risk adjustment.
• Possesses advanced knowledge of HCC risk adjustment, coding, and documentation requirements.
• Previous experience in a coding production environment such as Electronic Health Records.
• Capable of identifying and communicating trends in provider coding and documentation.
• Financial management skills, including the ability to analyze data for operations, auditing, and forecasting; basic accounting knowledge; and proficiency in staffing and financial reporting.
• Experience leading cross-organizational discussions and working with a matrixed team of stakeholders to achieve common goals.

PREFERRED QUALIFICATIONS

• Minimum of 4 years of progressively responsible experience in revenue cycle management, including knowledge of benefit and reimbursement coverage, billing and collection processes, medical coding, clinical documentation improvement, denials management, payment modeling, and regulations.
• Experience with Medicare and Medicare Advantage.
• CRC certification must be obtained within one year of hire (sponsorship will be provided).
• Experience with multi-state, federal, and jurisdictional payors and reimbursement.
• Project management experience.
• Experience in global process management, working across multiple time zones.
• Trained in HIPAA guidelines.

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