McKesson is in the business of better health and we touch the lives of patients in virtually every aspect of healthcare. At McKesson Specialty Health, our products and services span the full continuum of specialty patient care. From the initial phases of a product life cycle and the distribution of specialty drugs, to fully integrated healthcare technology systems, practice management support, and ultimately to patient care in the communities where they live, we empower the community patient care delivery system by helping community practices advance the science, technology and quality of care.
We have a vision that the long-term vibrancy of community care will be achieved through the leadership of physicians committed to clinical excellence and innovation, enabled by close collaboration with our organization and our deep clinical, operational and technological expertise. Every single McKesson employee contributes to our missionby joining McKesson Specialty Health you act as a catalyst in a chain of events that helps millions of people all over the globe. You'll collaborate on the products and solutions that help us carry out our mission to improve lives and advance healthcare. Working here is your opportunity to shape an industry that's vital to us all.
Join our team of leaders to begin a rewarding career.
Responsible for all revenue cycle billing and coding related services for the US Oncology Network and Vantage Oncology. Develops and leads the billing and coding quality chart review program for all major specialties in The Network to include medical oncology, radiation oncology, surgery and urology. Lead the billing and coding services team to serve as the subject matter experts in all billing and coding regulations, guidelines, CPT and physician documentation requirements related to both governments (CMS etc.) and commercial payer markets. Consults, advises and provides recommendation to the Network on billing and coding guidelines. Provide The Network with clear instruction on CMS regulations along with commercial payer medical policies. Represent as Network's revenue cycle billing and coding services leader for the practices and exhibit strong leadership qualities, excellent communication and presentation skills. Oversee and own the development and execution of quality chart review programs, training programs, physician/staff education, portal (ask the expert) and coding process improvement initiatives. Supports and adheres to The Compliance program, to include the Code of Ethics and Business Standards. Must be an advocate for the practice, be pro-active, curious, and possess a thorough knowledge of daily oncology treatments. This position requires maintaining a close working relationship with providers, practice staff and McKesson Specialty Health (MSH) staff.
Billing and Coding
Identifies physician and staff needs related to billing and coding and translates their needs to tangible executable solutions. Physician needs may include identifying and optimizing revenue opportunities related to billing and coding.
Publish periodic coding quality review reports to the Network physicians, practice and MSH leadership. Report on identified solutions and practice/physician progress related to billing and coding.
Owns the billing and coding related training material and delivery. Continuously revises the training material and delivery to meet the physician expectations in the Network.
Own the creation and usage of specialty specific coding playbook for the Network.
Through specialty specific program managers develops coding guidance for CPT, Diagnosis, HCPCS, and current and future regulatory requirements. Utilizes knowledge of revenue cycle management processes and procedures to maximize performance relative to practice relationship, satisfaction and appropriate key performance indicators.
Works collaboratively with McKesson resources (including the Compliance Department) to develop coding certifications, ICD-10 type implementation programs for the US Oncology Network. Supports all coding changes and pro-actively engages the Network to ensure all practices are abreast of current coding protocols.
Leads the billing and coding support services for practice revenue cycle management at all levels including coordinating education and re-education needs for revenue cycle staff and physicians. Works with practices to ensure coding and documentation compliance according to guidelines and policies.
Provides expertise and participates in technology and education committees, as needed. This would include the iKnowMed task force and MSH revenue cycle, OCM etc. teams. Assists with insurance carrier and CPT research on a regular basis informing departments of changes/updates as needed.
Leads the research related to government regulations and commercial payer policies. Responsible for preparation and dissemination of monthly newsletter to the Network.
Ensures appropriate maintenance of education physician and staff portals such as 'ask the expert'
Program Management and Leadership
Owns the billing and coding strategy, roadmap and execution for the Network including coding team structure, outsourcing coding services, vendor selection, physician/staff education programs, physician/staff portals and quality chart review programs.
Develops and leads the execution of billing and coding strategy for Network practices via the team of program managers and coding specialists that will consult with providers and practice management teams to set long term billing and coding strategies for each Network practice. May consult with providers and practice leadership team to set short and long term billing and coding strategies for their practices.
Leads a high performing team of program managers and coding educators and collaborates with coding staff and physicians in the Network to maintain optimal coding processes. Responsible for all program management and operations of the coding information and education department.
Owns the development and execution of the specialty specific chart review program across all major specialties to include Surgery, Urology, Medical Oncology and Radiation Oncology.
Ensures the billing and coding team informs and/or collaborates with the MSH compliance department in remediation of compliance related findings resulting from the chart review process.
Responsible for managing outsourced third party vendor relationships that provide billing and coding services such as quality chart reviews, coding, consulting etc. Maintains vendor relationships and own contract negotiations, pricing and service level agreements (SLA's) with the vendors. Ensures vendors provide the level of service committed per the SLA's and/or contracts.
Responsible to recommend and/or influence coding services that may be outsourced by independent practices in the Network.
Leads the development and maintenance of education materials (via webinars or other education delivery methods) with CME for the practices and physicians. Updates and maintains payer and drug alerts. Refreshes and keeps current materials on the reimbursement portal.
Ensures customer satisfaction levels of the Network physicians with services provided by the billing and coding services team.
Represents and periodically reports billing and coding department and Network related outcomes to MSH and practice leadership teams and Network physicians. Represents MSH billing and coding services and presents these outcomes during annual meetings such as annual Network conference and surgeons/urology conference etc.
Exhibits leadership in both strategic thinking and execution throughout the lifecycle of billing and coding services offered to the Network practices by ensuring appropriate solutions are developed and implemented in near and long terms.
Directly manages a team of three program managers and one admin specialist. Will indirectly manage a team of 10-15 team members including coding specialists who may report to the specialty specific program managers.
Minimum Job Qualifications
9+ years of medical claims experience along with strong leadership experience. Experience with patient information/claims system processes
Current coding certification (CPC, CCS-P or ROCC) with excellent coding skills with thorough knowledge of CPT-4 procedural coding methodology with ICD-10, ICD-9 diagnosis and HCPCS coding.
Experience in medical oncology, radiation oncology and surgery coding, medical records and reimbursement.
Knowledge of government and non-government regulations, guidelines and applicable reimbursement laws and regulations
Direct supervisory experience coaching, developing, and managing a remote staff
Four (4) years' experience working directly with and training Physicians and staff.
Proficiency in Microsoft Office (Outlook, Excel, Word, and PowerPoint)
Instructional educational experience with a CPC-I, CHC or like credential, preferred
Previous experience in a training environment and as an educator, preferred
Influencing skills of senior leaders to gain acceptance of best practices
Strong analytical, written, verbal and communication skills
Undergraduate degree in related field. Bachelor's degree in Business Administration, Finance, or Healthcare Administration highly desired. MBA preferred.
Work may require 40% travel by air or automobile.
Environment (Office, warehouse, travel, etc)-
The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment.
Physical Requirements (Lifting, standing, etc)
General office demands
Benefits & Company Statement
McKesson believes superior performance individual and team that helps us drive innovations and solutions to promote better health should be recognized and rewarded. We provide a competitive compensation program to attract, retain and motivate a high-performance workforce, and it's flexible enough to meet the different needs of our diverse employee population.
We are in the business of better health and we touch the lives of patients in virtually every aspect of healthcare. We partner with payers, hospitals, physician offices, pharmacies, pharmaceutical companies and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting.
But we can't do it without you. Every single McKesson employee contributes to our missionwhatever your title, whatever your role, you act as a catalyst in a chain of events that helps millions of people all over the globe. Talented, compassionate people are the future of our companyand of healthcare. At McKesson, you'll collaborate on the products and solutions that help us carry out our mission to improve lives and advance healthcare. Working here is your opportunity to shape an industry that's vital to us all.
McKesson is an equal opportunity and affirmative action employer minorities/females/veterans/persons with disabilities. Qualified applicants will not be disqualified from consideration for employment based upon criminal history.
No agencies please.