Position Purpose

Purpose Text

This position is responsible for the overall direction and daily operations of the coding functions for the departments within the integrated health network that impact the coding processes of inpatient and outpatient hospital operations. This position is responsible for the day-to-day management of coding staff to ensure timely coding/entry of ICD.9/ICD.10, and CPT codes, This position oversees the coding and workflows of daily unbilled accounts through work queues to ensure timely coding/billing and compliance. Development and maintenance of hospital coding policies and procedures, implementation of changes as appropriate, and, providing relevant feedback to coding staff is included within the scope of this position. The incumbent directs education programs to coding staff that support regulatory compliance, and clinical documentation improvement for accurate and complete coding, to substantiate reimbursement. In conjunction with the coding educator the position is responsible for creating and maintaining a coding trainee program.
Nature and Scope

Nature and Scope Text

This position creates and oversees all activities related to multi-facility inpatient and outpatient coding, rehabilitation, and Skilled Nursing coding; maintains a close working relationship with Revenue Integrity and Hospital Operations management to support coding accuracy that is consistent with industry standards and in compliance with the Official Guidelines for Coding and Reporting, including coordination with Clinical Documentation Specialists to ensure maximum MS-DRG reimbursement. This person is responsible for implementation of on-site and remote coding staff and support programs.

This person will be accountable for developing/maintaining a culture of service, financial discipline and fiscal responsibility, compliance, ethics and integrity; and maintains knowledge of and assures departmental compliance with Principles of Responsibility, policies and procedures, applicable regulatory requirements and accreditation standards. This responsibility is expressed through monitoring, audits, reporting of findings and education to the appropriate parties.

This person would oversee the reporting of prospective audit presentations to Leadership in conjunction with Coding and Performance plan. This would include reporting on denial management and A/R impacts.

This position seeks to support the integrity of coding. This person assesses and maintains impact of current compliance activities and evaluates risk factors of coding and documentation practices; and uses understanding of interrelationships among systems across functional areas to redesign processes, improve efficiency, and ensure optimal results for the future.

Work with the ICD-10 and clinical documentation improvement teams to design Coder processes that are efficient, ensure that they collect all required information, is traceable and is easy to access and complete by Coder(s).

The position shall be responsible for developing a team of both direct and indirect reports to establish an efficient management process to assure effective support of coding and documentation improvement through auditing and work flows in EPIC.
• Ability and desire to deal with detail and place in context of the big picture.
• Ability to fit in a matrix organizational structure.
• Excellent people skills and ability to work with diverse individuals in a complex organization and establish strong, cooperative working relationships.
• Excellent problem solving skills including the ability to identify trends and business opportunities and create recommendations.
• Skilled in developing presentations and presenting material.
• Strong knowledge of health care industry trends.
• Ability to complete monthly trending analysis of coding performance including weekly and monthly A/R reports.

Develop an education strategy highlighting the importance of the ICD-10 training program and how improved documentation will improve performance profiles and reimbursement.

Develop and manage the Hospital Coding Trainee program to reduce the need for contracted coding staff and eventually be able to outsource our own coders to outside health care facilities.

This position is responsible for developing, planning, maintaining, and coordinating orientation programs and in-services for staff development competency validation programs and rotations for coding trainees

This position faces the major challenges of fostering positive relationships between physicians, the community, and the organization with the purpose of maintaining cost-effective and high-quality documentation; designing and coordinating educational programs; complying with state, federal and governing body regulations; and working cooperatively with other departments to achieve goals of the organization.

This position has access to proprietary information and has contact with external organizations, which mandates high standards of professionalism, communication, performance, and respect for confidentiality.

This position does not provide patient care
Disclaimer

The foregoing description is not intended to be, and should not be construed as, an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.
Minimum Qualifications

Requirements - Required and/or Preferred
MinQual

NameDescription
Education:

Ability to read, write, speak, and understand English sufficiently to perform job duties safely and effectively. Bachelors Degree from an accredited college is required or may substitute degree with years of experience on a year for year basis.

Experience:

Requires a minimum of 5 years ICD-10 and CPT coding management/leadership level experience.

License(s):

None

Certification(s):

CCS or CPC is required. RHIA and/or RHIT preferred.

Computer / Typing:

Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel, Teams, and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.