II. Principle Responsibilities and Tasks
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
- Oversees the management of Outpatient coding compliance and quality across the health system. Manages accurate assignment of ICD-10 diagnostic codes and CPT-4 procedure codes to outpatient, ambulatory surgery, observation, and other OP visits for the purpose of reimbursement, research and compliance with federal and state regulations. Utilizes strategic thinking to analyze and evaluate Outpatient documentation issues with consultation from Clinical staff, Clinical Documentation Specialists, and Coding Quality as needed. Manages Denials & DNFB Analyst to ensure resolution of claim edits and DNFB holds. Maintains quality and accuracy standards for community, trauma, and specialty facilities. Analyze audited data to identify trends, identify areas of opportunity, or assess potential compliance risks. Implement corrective measures to aid in organizational success. Provide an open and goal-oriented work environment with established, clear and concise work procedures and productivity standards. Participates in budget development and recommends budgets for areas of oversight. Tracks spending to budget for areas of oversight.
- Monitors and reinforce standard workflow. Evaluate and establish criteria to support standard work. Manages accounts receivables on a daily basis in order to facilitate the billing process within the established timeframes across the health system. Manages outpatient coding leadership to ensure accurate and timely workflow completion within established timeframes for each patient type. Organize and coordinate local outpatient program specific meetings for local facilities to address outpatient documentation/coding concerns at a program/clinic level. Ensure timely submission for coded data, audit updates, and resolution of HSCRC errors for timely HSCRC submission. Responsible for completion of outpatient regression testing. Coach and develop leaders to maintain a strong remote workforce, maintaining high moral and employee engagement. Maintain strong teamwork across all areas of responsibility. Collaborate with auditing team for audit reviews, training, and on-going education with minimal disruption to coding workflow. Monitors the use of contract labor and overtime against operational budget and bill hold goals.
- Communicates with senior leadership and key stakeholders within the hospitals regarding coding metrics. Maintains appropriate coverage and associate workload. Oversees bill holds to maintain financial stability of organization. Communicates, monitors, and verifies outpatient coding productivity and coding quality reports for the system hospitals and holds managers accountable for their performance. Works closely with outpatient leadership to ensure continuous outpatient improvement in areas of productivity, coding accuracy, employee satisfaction. Works collaboratively with key stakeholders to ensure goals associated with but not limited to, Risk Adjusted Coding, Population Health, NCCI edits, & medical necessity are met.
- Hires employees. Oversees orientation and training of new coders.
- Conducts performance evaluations, handle corrective actions, and provides an open and goal oriented work environment with established clear and concise work procedures and productivity standards. Assists and trains coders on composition of appropriate coding queries. Reviews recommendations from supervisors and provides guidance or counseling to staff regarding employee relation matters.
- Complies with AHIMA standards of ethical coding and coding compliance guidelines.
- Demonstrates support and compliance with University of Maryland Medical System mission, vision, values statement, goals and objectives and policies. Performs other duties or projects such as assigned. Attends seminars and in-services as required to remain current ongoing issues.
What You Need to Be Successful:
III. Education and Experience
- Bachelor’s degree in related field or 10 years’ experience. Master’s degree in related field preferred.
- 7 years’ experience with coding outpatient hospital medical records.
- 5 years supervisory experience/management experience required in the coding field, supervising professional/supervisory staff.
- One of the following: Certified Coding Specialist (CCS), Certified Professional Coder (CPC), AHIMA Approved ICD10CM/PCS Trainer
- Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA) preferred.