SummaryThe Health Information Management Manager plans, budgets, organizes and directs Health Information Management and Clinical Documentation Integrity services for the hospital and its provider clinics. The position is accountable for complete, accurate and timely coding and documentation, which drives clean claims, appropriate reimbursement and a controlled unbilled (DNFB) balance. The manager also ensures the confidentiality, integrity and availability of the legal health record and compliance with federal, state, accreditation and payer requirements.
Essential Duties and Responsibilities1. Coding and Revenue Integrity- Directs all coding operations: inpatient (MS-DRG and other payer-required DRG systems), outpatient, emergency and observation (APC/OPPS), and provider clinic coding (CPT, HCPCS, E/M and HCC risk adjustment).
- Owns measurable unbilled targets and reports them weekly: DNFB dollars and days, coding turnaround , and aging of accounts held for coding.
- Maintains an escalation process for coding holds and documentation delays, including missing diagnoses, emergency physician notes, discharge summaries and operative reports.
- Sets and enforces coding productivity and accuracy standards; conducts internal coding audits and coordinates external audits.
- Implements annual and quarterly code set updates (ICD-10-CM/PCS each October 1; CPT/HCPCS each January 1 and quarterly) with education and system updates.
- Partners with Revenue Cycle, and Charge Description Master (CDM) to resolve coding-related claim edits (NCCI, MUE, scrubber and payer edits).
- Manage outsourced and remote coding vendors, including contract terms, performance targets and audit results.
2. Clinical Documentation Integrity (CDI)- Leads the CDI program for inpatient services.
- Supports accurate risk adjustment (HCC) documentation for Medicare Advantage and other value-based populations.
- Ensures all physician queries are compliant with AHIMA/ACDIS query practice guidelines.
- Monitors and reports CDI performance: case mix index, CC/MCC capture, severity of illness and risk of mortality, query volume, response rate and agreement rate.
- Provides education for physicians, advanced practice providers and clinical staff.
3. Denials, Audits and Appeals- Manages coding and clinical documentation denials, including DRG downgrades, medical necessity and coding edit denials; prepares or oversees appeals.
- Coordinates responses to external audits and record requests in conjunction with the RAC Auditor: RAC, MAC/TPE, UPIC, OIG, and Medicare Advantage and Medicaid managed care plan audits.
- Tracks denial root causes and reports trends and corrective actions monthly to revenue cycle leadership.
4. Physician Record Completion- Manages record deficiency tracking by provider for the hospital and enforces Medical Staff Bylaws and Rules and Regulations for timely completion of discharge summaries, operative reports, emergency notes, history and physicals, and authentications.
- Maintains delinquent records at or below The Joint Commission threshold and reports delinquency to the Medical Executive Committee.
5. Provider Clinics- Oversees documentation, coding and health record standards for all system-owned provider clinics, including E/M guideline education for providers.
- Standardizes scanning, indexing, release of information and record retention processes across all locations.
- Ensures documentation and billing support meet the requirements of each clinic's designation.
6. Release of Information, Privacy and Records Management- Ensures patient right-of-access requests are fulfilled within HIPAA timelines and in compliance with 21st Century Cures Act information blocking rules, including patient portal access.
- Manages subpoenas, court orders, legal holds, amendment requests and accounting of disclosures; oversees release-of-information vendors.
- Partners with the the Compliance Officer on access audits, breach investigations and privacy education.
- Maintains Master Patient Index (MPI) integrity, including duplicate record identification, merges and overlay correction.
- Maintains the legal health record definition, designated record set and record retention and destruction schedules in accordance with Louisiana law and federal requirements.
- Oversees birth certificate and vital records processing.
7. Data and Technology- Serves as HIM lead for EHR optimization, encoder and computer-assisted coding tools, document imaging, and EHR downtime procedures.
- Evaluates emerging technologies, including AI-assisted documentation and coding, for accuracy, compliance and return on investment.
- Produces a monthly HIM dashboard covering DNFB, coding turnaround, coding accuracy, delinquent records, release-of-information turnaround, CDI metrics and coding-related denials.
8. Leadership, Staffing and Financial Management- Keeps hospital administration informed of departmental activities, performance, risks and needs.
- Develops, implements and revises HIM and CDI policies and procedures, and ensures compliance with The Joint Commission, CMS Conditions of Participation, Louisiana Department of Health and other regulatory requirements.
- Sets annual department goals aligned with the hospital's strategic plan and monitors progress.
- Staffs the department to productivity standards; recruits, hires, trains, develops and evaluates staff.
- Prepares and manages the department operating budget, including vendor and outsourced coding costs.
- Ensure staff maintain required credentials and continuing education, and maintains own AHIMA credentials.
Standards of BehaviorEmployee must be both committed to and accountable for demonstrating supportiveness, etiquette, respect, vibrancy, integrity, communication, and excellence in service delivery by adhering to the behaviors specified in the Service Standards of Behavior.
Minimum QualificationsCategory
Requirement
Required / Preferred
Education
Bachelor's degree in Health Information Management or a related field
Required
Education
Master's degree in HIM, Health Administration or Business
Preferred
Certification
Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT) with a bachelor's degree and significant HIM leadership experience
Required
Certification
CCS, CDIP or CCDS, and/or CPC
Preferred
Experience
5 years in Health Information Management, including inpatient and outpatient coding or CDI
Required
Experience
4 years of supervisory or management experience
Required
Experience
Physician practice or clinic coding and documentation
Preferred
Experience
Oracle Health (Cerner) EHR and Encoder systems
Preferred
Physical DemandsThe position is primarily office-based and sedentary, with regular computer use.
Activity
Frequency
Sitting
Regularly
Standing, walking
Frequently
Talking, hearing, close vision
Regularly
Fine motor activities, repetitive motion (keyboard)
Regularly
Reaching with arms and hands
Frequently
Climbing stairs
Occasionally
Stooping, kneeling, crouching
Occasionally
Lifting or moving up to 10 pounds
Frequently
Lifting or moving up to 25 pounds
Occasionally
Environment RequirementsBloodborne pathogens, chemical, airborne communicable disease, extreme temperature and noise exposure are not anticipated.
Employee Statement of UnderstandingI have read and understand the job description for my position. I am able to perform all of the essential functions of this position.
The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position.
The job description does not constitute an employment agreement between the Hospital and the employee. The job description is subject to change as the needs of the Hospital and requirements of the job change.
