Health Information Management Coding Manager-Full Time

JOB SUMMARY Responsible for the daily operations of the inpatient and outpatient coding services.
JOB REQUIREMENTS Minimum Education HS Diploma or equivalent required.
Associates or Bachelors degree in Health Information Management or related field of study preferred.
Minimum Work Experience 5 - 7 years’ experience in general acute care coding.
Requires advanced knowledge of ICD 9-CM; ICD – 10-CM; ICD-10-PCS; CPT-4; HCPCS coding systems.
Required Licenses Coder, Certified Coding Specialist (CCS); Prefer Registered Health Information Technician/Administrator (RHIT/RHIA).
Required Skills Requires advanced knowledge of ICD-10-CM; ICD-10-PCS; CPT-4; and HCPCS coding systems.
NONESSENTIAL FUNCTIONS Other duties as assigned.
FUNCTIONAL DEMANDS Reports to: Director of Health Information Management Supervises: Coding, and Clinical Documentation Improvement staff Physical Demands: Regularly (R), Periodically (P), Essential (E), or Non-Essential Vision (Corrected/Normal): (R) & (E)Colored Vision: (P) & (NE)Hearing (Corrected/Normal): (P) & (NE)Finger Dexterity: (R) & (E)Clear Oral Communication: (P)Pushing: (P)Lifting: (R)Lifting (Floor to Waist): (P)Lifting—12” to waist: (P)Lifting—Waist to Shoulders: (P)Lifting—Shoulder to Overhead: (P)Reaching Overhead: (P)Reaching Forward: (R)Carrying: (R)Standing: (P)Sitting: (R)Squatting: (P)Stooping: (P)Kneeling: (P)Walking : (R)Stairs (Ascending/Descending): (P)Turning (Head/Neck): (R)Repetitive Leg/Arm Movement: (R) ORGANIZATIONAL EXPECTATIONS Organizational Expectations: · Provides a positive and professional representation of the organization.
· Promotes culture of safety for patients and employees through proper identification, reporting, documentation, and prevention.
· Maintains hospital standards for a clean and quiet patient environment to maintain a positive patient care experience.
· Maintains competency and knowledge of current standards of practice, trends, and developments in related scope of job role or practice.
· Adheres to infection-control policies and protocols, medication administration and storage procedures, and controlled substance regulations.
· Participates in ongoing quality improvement activities.
· Maintains compliance with organization’s policies, as well as established practices, protocols, and procedures of the position, department, and applicable professional standards.
· Complies with organizational and regulatory policies for handling confidential patient information.
· Demonstrates excellent customer service through his/her attitude and actions, consistent with the standards contained in the Vision, Mission, and Values of the organization.
· Adheres to professional standards, hospital policies and procedures, federal, state, and local requirements, and TJC standards and/or standards from other accrediting bodies.
· As a Studer Partner must have the ability to develop a full understanding of the Studer Group practices and tools and communicate effectively.
· Must embrace the Studer Philosophy and Principals by conducting him/herself in a professional manner.
Will be held accountable to the following Studer Philosophies and Principles:• HCAPS Patient Perception• Hourly Rounding with intention• Bedside Shift Report• AIDET• Daily Huddles ESSENTIAL FUNCTIONS · Identifies communicates, and ensures that coding unit staff meet productivity, timeliness and quality standards to support the financial goals of the organization.
· Serves as the primary liaison position between the Medical Center and the Medical Staff for the clinical documentation required to accurately and completely document the level of patient care provided, to support data collection/utilization and assignment of diagnosis and procedure codes.
· Ensures that documentation and coding practices meet National practice guidelines and the compliance goals of the organization, managing State and Federal regulatory and other monitoring agencies as well as private carrier requirements, external audit and the Kentucky State reporting functions.
· Provides guidance and motivation to staff regarding identifying activities/areas where performance can be improved.
· Provides oversight to the ongoing operation or selection of electronic coding or documentation improvement software, interfaces with billing systems and workflow changes with computerized patient information.
· Coordinates/provider for the necessary educational programs for Coding and Clinical Documentation staff.
· Provides/arranges for training for facility healthcare professionals in the use of technical coding guidelines and practices, proper documentation techniques, medical terminology and disease as they relate to DRG, APC and other data quality management.
· Coordinates the reconciliation process between the CDI Specialist(s) and the Coding staff.
· Maintains quality reviews/audits of cases affected by the CDI process.
Monitors CDI quality reports for efficiency, quality and potential improvements.
· Coordinates/communicates new CDI initiatives/information to the medical staff, Revenue Cycle, other hospital departments and other key stakeholders.
· Produces data/statistics and measurement reports to leadership of CDI processes, progress and improvement.
· Ensures that extracted data is tracked, trended and translated into actionable outcomes.
· Provides decision support, operational planning and operational leadership for CDI operations and educates accordingly.
· Assists in managing the Un-coded by ensuring prompt query responses concurrently.
· Serves as liaison for organizational departments requiring assistance with coding of accounts and/or information about coding and/or documentation.
· Assists Patient Financial services with claims process as it relates to coding issues.
· Interacts with other JSMC Departments that utilize coding data to assist with correct interpretation and response to queries.
· Serves as a member of the Revenue Cycle Committee, as well as, other key committees involving documentation and /or coding.
· Establishes, implements, and maintains a formalized review process for coding compliance, including formal review (audit) process; designs and uses audit tools to monitor the accuracy of clinical coding.
· Reviews external coder audits for agreement with findings and disputes findings with reviewer when not in agreement.
· Responds to audit inquiries and findings as appropriate.
· Performs data quality reviews on inpatient records to validate the code assignment (ICD-10 and CPT-4/HCPCS); modifier assignments; verifies Ambulatory Payment Classification (APC) group appropriateness; checks for missed secondary diagnoses and/or procedures and ensures compliance with a APC mandates and outpatient reporting requirements.
· Creates and monitors inpatient case mix reports and the top DRG's in the facility to identify patterns, trends and variations in the facility's frequently assigned DRG groups; investigates and evaluates potential causes for changes or problems; takes appropriate steps in collaboration with the right staff to effect resolution or explain variances.
· Creates and monitors outpatient services mix reports and the leading medical visit, surgical service, significant procedure, and ancillary APC's assigned in the facility to identify patterns, trends, and variations in the facility's frequently assigned APC Groups; takes appropriate steps in collaboration with the right staff to effect resolution or explain variances.
· Remains informed about transaction code sets, HIPAA requirements, and other issues impacting health information management functions; keeps abreast of new technology in coding and abstracting software and other forms of automation; and maintains current knowledge through certifications as appropriate.
May perform the most technical, complex and difficult coding and abstraction work.
· Monitors unbilled accounts report for outstanding services or un-coded discharges to reduce accounts receivable days for inpatients and/or outpatients; performs periodic claim for reviews to check code transfer accuracy from the abstracting software and the charge master.
· Collects and prepares data for studies involving inpatient stays and outpatient encounters for clinical evaluation purposes; prepares and maintains a variety of complex records and reports Required Skills 5 - 7 years’ experience in general acute care coding.
Requires advanced knowledge of ICD 9-CM; ICD – 10-CM; ICD-10-PCS; CPT-4; HCPCS coding systems.
Required Experience 5 - 7 years’ experience in general acute care coding.
Requires advanced knowledge of ICD 9-CM; ICD – 10-CM; ICD-10-PCS; CPT-4; HCPCS coding systems.