Regulatory Services Supervisor

Job Description

Job Description

Regulatory Services Supervisor
FLSA: Exempt

About us

Physicians East, P.A.is a team of skilled healthcare professionals united to meet the challenge of delivering quality, cost-efficient, comprehensive healthcare to the people of Eastern North Carolina.

About the role

We are looking for an employee that can supervise coders and all administrative staff of the Regulatory Services Department. Hybrid role - predominantly remote with some on site requirement as needed.

Supervision Received: Reports to Regulatory Services Manager.

Supervision Exercised: Supervises the regulatory services department in their daily duties and activities.

Typical Physical Demands: Requires prolonged standing or sitting while working in an office environment. Requires some bending or stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, and other office equipment. Requires the ability to distinguish between letters and/or symbols. Requires normal vision range and the absence of color-blindness.

Typical Working Conditions:

Hybrid role - predominantly remote with some on site requirement as needed.

Responsibilities

• Supervises coding services daily to ensure coding levels and charting meets standards and regulations

• Provides supervisory oversight to department administrative roles

• Informs manager of revisions needed to encounter forms, EHR documentation system, or practice management billing and edit system impacting billable diagnoses or procedures

• Remains current on all regulatory coding changes, payor specific requirements, and coding processes that affect reimbursement and contract allowable to ensure proper payment

• Conducts and trains staff on coding service levels to ensure documentation supported the level of Evaluation and Management charged

• Completes analysis, charts, and spreadsheets to present coding and coding denial outcomes to manager

• Educates physicians and employees on coding issues by specialty when coding or documentation issues are identified

• Communicate with Coding, Insurance Supervisors, Medicare and BCBS Team members regarding denial trends, problematic denials, reimbursement issues, appeals, and rebilling of claims

• Research and correct claims to validate denial adjustments and ensure secondary claims are not held up due to coding issues

• Reports all identified compliance audit issues or repetitive use of noncovered diagnoses or codes not paying according to contractual fees schedules to Regulatory Services Manager

• Assists internal departments with third party payer coding rules and regulation questions

• Shares information as necessary and provides other assistance to the Auditing, Coding and/or Insurance Department as directed by the Regulatory Services Manager

• Reports all identified coding compliance audit issues to the Regulatory Services Manager

• Maintains patient confidentiality

• Coordinate’s student interns from H.I.T. and H.I.M. Programs completing PPE assignment

• Prepares weekly student schedules, assignments, and relevant appointments

• Attends meetings when required

Location & commitments

Full-time role based at our Greenville Arlington Blvd. location, Monday-Friday, 8a.m. – 5 p.m.

Overtime may be required to ensure patients are taken care, tasks are completed, and calls are returned in a timely manner.

Weekend work is rare but can occasionally be necessary.

Candidate requirements

• Bachelor’s degree in health information services with RHIA certification and 2-3 years of multi-specialty ICD-10, CPT/HCPCS coding experience

• Associates degree in health information technology with RHIT certification and 3-5 years of multi-specialty ICD-10, CPT/HCPCS experience

• CCS/CCS-P certification with additional CPC certification and 4-6 years of multi-specialty ICD-10, CPT/HCPCS experience

• 3 plus years of Medicare and commercial coding/billing experience in a multi-specialty practice required

• Must have strong keyboarding, software, analytical and organizational skills. Must possess strong understanding of customer service principles and have well-developed written and oral skills.

Affirmative Action/EEO statement

Physicians East, P.A.is an equal opportunity employer and will not discriminate against any applicant or employee on the basis of age, race, color, ethnicity, religion, creed, sex (including gender, pregnancy, sexual orientation, and gender identity, which includes status as a transgender individual), national origin or ancestry, citizenship, past, current, or prospective service in the uniformed services, genetic information (including family medical history), physical or mental disability, or other legally protected status. Reasonable accommodation will be made for persons with disabilities during the application process and/or at the time of employment. Requests for accommodation should be made to the Human Resources Department as early as possible in the application/employment process. Contact HR Office at 252-413-6368 or email [email protected]

Disclaimer

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Signatures

This job description has been approved by:

Manager_____________________________________ Date ____________

HR__________________________________________ Date _________________

Employee signature below indicates the employee's understanding of the requirements, essential functions, and duties of the position.

Employee______________________________________ Date__________________