Work Shifts
8:00 A.M - 4:00 P.M; Monday to Friday
. *[35 Hours per Week.]Duties & ResponsibilitiesSUMMARY OF DUTIES AND RESPONSIBILITIES:
Under the direction of the HIM Director, the Assistant Director of HIM (Coding), analyzes provider documentation claims data, and assigned codes for all diagnoses and procedures to ensure accurate Diagnosis-Related Group (DRG) assignment. This role ensures that the most precise and comprehensive ICD-10-CM/PCS, CPT, and HCPCS codes appropriately support the patient's clinical care and accurately reflect severity of illness and risk of mortality. The individual conducts comprehensive quality reviews of medical records; validates the appropriateness of coding and DRG assignment; and provides expert guidance to promote consistency, accuracy, and efficiency in coding, data integrity and quality reporting.
General tasks and responsibilities will include:
1. Performs coding reviews to validate the completeness, accuracy, and specificity of code assignments for inpatient records in accordance with established coding guidelines and enterprise policies and procedures for appropriate DRG assignment. Ensures that all documented diagnoses and procedures are properly coded.
2. Validates the completeness, accuracy, and specificity of code assignments for Inpatient, Emergency Department and Ambulatory Surgery records, in accordance with established coding guidelines to support HCC capture and CRGs.
3. Participates in data quality reviews on inpatient records to validate the ICD-10 codes, MS-DRG, and APR-DRG, identify missed secondary diagnoses and procedures, PSIs, HACs and ensures compliance with all DRG mandates and reporting requirements. Analyze reports and identifies trends and statistical significance in quality metrics that will assist with focused as well as organizational process improvement.
4. Participates in the denials and appeals process by reviewing cases denied and making the determination whether or not a case is appealable by using pre-established criteria, based facility policies and procedures. Ensures denials are responded to in a timely manner. Provides feedback to facility coders, validators and physician advisors on opportunities in collaboration with CDI.
5. Assists in the development, implementation, and management of organizational strategy, initiatives, and/or budget and performance standards; communicates organizational objectives and goals.
6. Identifies and reports on cases with documentation inadequacies, inconsistencies, and other issues with opportunities for improvement and collaborates with enterprise CDI reviewers to provide feedback and education to facility coders, DRG validators and CDIs.
7. Generates physician queries as needed in order to obtain clarification of medical record documentation. Validates that physicians have been queried according to established procedure. Provide feedback to facilities on missed query opportunities in collaboration with CDI.
8. Serves as departmental representative through participation in various facility and corporate wide committees, work groups, and/or initiatives. Assists in interdisciplinary efforts to review existing documentation and coding policies and procedures and makes necessary recommendations for improvement.
9. Instructs physicians, nurses, health information management staff, and other appropriate personnel regarding documentation requirements as related to coding.
10. Educate and mentors facility coding and validation staff. Provides orientation and boot camp training which includes new topics in coding (inpatient and outpatient), chart review, reimbursement and regulatory changes. Provides readiness assessments of new coding staff.
11. Performs coding quality audits of records for ICD-10-CM, CPT, and PCS, as well as MS/APR DRGs assignment to ensure functions of the CDI and coding team are performed with a high degree of accuracy.
12. Reviews coding edits for accuracy and provides feedback and education.
13. Identify trends and patterns in coding and documentation variances, monitor quality and provide education to ensure compliance with pertinent regulations and guidelines.
14. Research coding updates, new procedures, and disease pathophysiology and documentation requirements. Provide presentation/educational materials (recognized resources) to CDI and Coding staff.
15. Implement coding initiatives, goals and objectives for all facilities. This position oversees all ongoing activities related to the development, implementation and maintenance of inpatient and outpatient coding policies.
16. Ensures all coding and CDI staff abides by the standards of ethical coding as set forth and updated by AHIMA and ACDIS.
17. Performs all related assignments.
Minimum Qualifications1. Bachelor's Degree from an accredited college or university in Business Administration, Health Information Management, Health Administration, Industrial Engineering or a related discipline;
and2. Three (3) years of satisfactory experience in business, government, hospital or related health care organization in medical records services and systems, of which at least one (1) year must have been in a managerial, administrative and/or supervisory capacity.
3. All candidates must maintain a Registered Health Information Administrator (RHIA) credential from the
American Health Information Management Association (AHIMA) or a Registered Health Information Technician (RHIT) credential from AHIMA.
Department Preferences• Minimum of 2 years' experience as a DRG Validator, combined with at least 3 years' coding experience in an acute care setting.
• Certifications / NYS Licenses (One or more required):
• Certified Coding Specialist (CCS)
• Certified Professional Coder (CPC)
• Registered Health Information Administrator (RHIA)
• Registered Health Information Technician (RHIT)
Key Responsibilities & Operational Impact
• Advanced DRG & Quality Validation: Applies expertise in second-level reviews, clinical validation, coding escalation processes, and peer review standards to maintain enterprise-wide accuracy and consistency.
• Documentation & Provider Engagement: Identifies documentation gaps, analyzes provider documentation patterns, and aligns with Clinical Documentation Improvement (CDI) workflows and physician query standards to promote compliant, defensible practices.
• Financial & Performance Strategy: Evaluates the downstream impact of coding decisions on Case Mix Index (CMI), inpatient reimbursement, billing, quality outcomes, and publicly reported measures.
• Audit Readiness & Compliance: Oversees data governance and ensures complete documentation to support regulatory reviews, payer audit readiness, denial management, and appeals.
Technical & Professional Knowledge
• Payment & Coding Methodologies: In-depth understanding of MS-DRG methodology, the Medicare Inpatient Prospective Payment System (IPPS), and expert command of ICD-10-CM/PCS Official Coding Guidelines.
• Clinical & Quality Analytics: Strong grasp of clinical validation principles-including Severity of Illness (SOI) and Risk of Mortality (ROM)-alongside quality indicators such as Patient Safety Indicators (PSIs), Hospital-Acquired Conditions (HACs), and mortality measures.
• Payer & Regulatory Standards: Familiarity with payer policies, medical necessity criteria, denial trends, and general compliance requirements governing inpatient reimbursement.
• Systems & Tools: Proficiency with Electronic Health Record (EHR) systems, coding encoders, and auditing or validation software.
BenefitsNYC Health and Hospitals offers a competitive benefits package that includes:
- Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
- Retirement Savings and Pension Plans
- Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
- Loan Forgiveness Programs for eligible employees
- College tuition discounts and professional development opportunities
- College Savings Program
- Union Benefits for eligible titles
- Multiple employee discounts programs
- Commuter Benefits Programs
If you wish to apply for this position, please apply online by clicking the "Apply for Job" button.
