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MEDICAL CODING MANAGER

ADMINISTRATIVE OFFICER III

Recruitment #15-002247-0027

GRADE

15

LOCATION OF POSITION

Baltimore City

Main Purpose of Job

The Medical Coding Manager is a working supervisory position and is responsible for providing day-to-day oversight for assigned codes. Will facilitate and process issues that arise, be the point-of-contact for coding questions, processes and/or codes, and escalate any quality or productivity issues to the Division Director. It requires an individual who has extensive knowledge of CMS Relative Value Unit based pricing systems, management principles and practices, analytical and evaluative methods and has the ability to plan, organize and direct the work of others. The position will provide technical assistance to the Commission and must possess the ability to research, analyze and identify trends in health care utilization, study MEDPAC announcements and consult on the current changes to Medicare reimbursement rates and payment policies; serves as the technical expert on WCC Medical Fee Guide related matters in consult with the Commission, the medical fee guide committee and the workers' compensation community; processes accurate procedural and diagnosis coding used by providers submitting medical claims for reimbursement; processing Commission orders; communicates and instructs the workers' compensation community on changes/revisions to the fee, attorneys, and injured workers and provide information to the public regarding the MFG. This position is also responsible for assisting with various administrative duties relating to Vocational Rehabilitation, including but not limited to the maintenance of provider rosters and databases.

POSITION DUTIES

ADMINISTRATION/SUPERVISON:
• Supervises support personnel, which includes work allocation, training, and problem resolution; evaluates performance and makes recommendations for personnel actions; motivates employees to achieve peak productivity and performance.
• Ensures that all staff maintains required certifications and is current with all industry related information.
• Determines and establishes set procedures in order to carry out daily functions and to ensure compliance with legal and regulatory requirements.
• Coordinates team member time off in a manner that does not negatively impact necessary daily functions.
• Participates in the development and implementation of departmental operating policies and procedures.
• Assists Medical Director in preparing and distributing Medical Factoids to the Commissioners relating to current trends and findings.
• Conducts and attends regularly scheduled staff meetings, attends quarterly Joint Director & Supervisory meetings, attends Monthly Director’s meeting in the absence of the Director of Support Services.
• Attends and participates in other Commission meetings as deemed necessary.
• Assists the Director of Support Services in assuring that the Division is in compliance with the Commission’s goals and objectives contained in the Managing for Results (“MFR”).
• Assists the Director of Support Services in assuring compliance with the Division’s annual budget request.
• Assists the Director of Support Services in identifying, implementing and monitoring new initiatives for the Division’s units to attain a more efficient and effective operation.

MEDICAL SERVICES/MEDICAL FEE GUIDE & COMMITTEE 
• Serves as the practice expert and go to person for all coding processes and CMS matters.
• Review, interpret, code and analyze general, ambulatory center and hospital billing and claims for accuracy and completeness and compliance with established laws and regulations and WCC Medical Fee Guide.
• Process Order Nisi and Final Order Nisi as required.
• Ensures that the activities of the coding operations are conducted in a manner that is consistent with overall department protocol, and are in compliance with all applicable regulations.
• Maintain required coding certification and remain current with knowledge of all coding, industry and health information management and compliance matters.
• Maintains library of information/tools related to documentation guidelines and coding.
• Research, analyze and present trends impacting charges, coding and the WCC Medical Fee Guide and take appropriate action to provide a written summary of finding to the Chairman of the Medical Fee Guide Committee, Chief Executive Officer, Chief Operating Officer, Medical Director and Director of Support Services. • Prepares and analyzes reports, monthly statistical reports and updates and maintains the annual WCC Medical Fee Guide based on the requirements as specified by regulation LE 14.09.08.
• Keep up to date with CMS, MEDPAC, and other related agency rules and rate changes and distribute the information to the Medical Director for review.
• Coordinates the meeting logistics for the WCC Medical Fee Guide Committee as requested by the Chairman of the Medical Fee Guide
Committee, including scheduling and recording meeting minutes.
• Complies with Open Meeting Act Requirements.
• Regularly communicates with peers to keep abreast of any issues or concerns that the industry may have that the Commission should be aware of that could result in an access to care issue or other relevant concern.

VOCATIONAL REHABILITATION SERVICES
• Provide support and assistance in the vocational rehabilitation duties, including but not limited to the training and certification tracking, weekly maintenance of the published list of registered Practioner and Provider web roster and database. Compiling and maintaining current and accurate data for all providers based on incoming applications and renewal applications. Per COMAR 14.09.07.09 (C), the Rehabilitation Division is responsible for updating and maintaining all information related to the program and publishing that information on the website.
• Assist in processing orders on vocational rehabilitation plans reviewed and approved by the Director of Support Services.

MINIMUM QUALIFICATIONS

Education: Possession of a bachelor's degree from an accredited four-year college or university.

Experience: Three years experience in administrative or professional work.

Notes:

1. Candidates may substitute additional experience in administrative staff or professional work on a year-for-year basis for the required education.

 2. Candidates may substitute additional graduate level education at an accredited college or university at the rate of 30 semester credit hours for each year of the required experience.

3. Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer involving staff work that included the regular independent judgment and analysis in applying and interpreting complex administrative plans, policies, rules or regulations or analysis of operational programs or procedures with recommendations for improvement on a year to year basis for the required education and experience.  

SELECTIVE QUALIFICATIONS

The following is a required qualification. Candidates MUST possess the following:

One year of interpreting Medicare policies with regard to reimbursement rates and payment policies, if the education substitution is not being used to meet the minimum qualifications

DESIRED OR PREFERRED QUALIFICATIONS

1.      One year of experience in the development of spreadsheets and databases and importing/exporting files using Microsoft Excel.

2.      Possession of an active Certificate in Medical Coding, i.e. CPC, CPC-H etc.

LICENSES, REGISTRATIONS AND CERTIFICATIONS

Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties will be required to possess a motor vehicle operator’s license valid in the State of Maryland.

SELECTION PROCESS

The examination will consist of a rating of your training and experience as provided with your application. Please make sure that you provide sufficient information on your application to show that you meet the qualifications for this recruitment.

Please include your resume along with your completed online employment application. During the online application process, use the Resume tab to select a method for including your resume (Upload Your Resume or Type or Copy/Paste Your Resume).

All information concerning your qualifications must be submitted by the closing date. We will not consider information submitted after this date. Successful candidates will be ranked as Best Qualified, Better Qualified, or Qualified and placed on the employment (eligible) list for at least one year.

BENEFITS

FURTHER INSTRUCTIONS

TO APPLY: Please include your resume along with your completed online employment application. During the online application process, use the Resume tab to select a method for including your resume (Upload Your Resume or Type or Copy/Paste Your Resume).

If you are unable to apply online, or encounter difficulty attaching required or optional documentation, you may submit via mail or deliver in person. Please be sure to include your name, identification number (Easy ID#) and job announcement number on any documentation to ensure timely processing. Please include your resume along with your completed employment application.

PLEASE DO NOT FAX OR EMAIL UNSOLICITED DOCUMENTATION

Completed applications, required documentation, and any required addendums may be mailed to:

Workers' Compensation Commission
Attn: 15-00247-0027
10 E. Baltimore Street, Personnel Division
Baltimore, MD 21202

TTY Users: call via Maryland Relay

We thank our Veterans for their service to our country, and encourage them to apply.

WCC is an equal opportunity employer. It is the policy of WCC that all persons have equal opportunity and access to employment opportunities, services, and facilities without regard to race, religion, color, sex, age, national origin or ancestry, marital status, parental status, sexual orientation, disability or veteran status.




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