Admin Manager Inpatient Coding and Coding Quality

Position Title:

Department:

Job Description:

General Description: The Coding Manager is responsible for assisting in the development and evolution of the overall strategy for the Company’s coding operations. The Coding Manager manages, directs and coordinates the coding activities for the Company while driving strategic initiatives for overall company coding expectations and goals. Responsibilities include management of process, outcomes and personnel. The Coding Manager plans, assigns and directs the HIM coding and DRG/code validation workflow; actively monitors employee performance and rewards or disciplines accordingly; addresses complaints and resolves problems; and actively oversees and manages production and quality control efforts.

Essential Responsibilities:

• Provides direct managerial oversight to:
  • Coding Integrity Specialists (CISs) I, II, and III, Coding Quality Reviewer/Educator(s), and Coding Lead(s) in management of all work processes and overall work responsibilities.

• Ensures complete, accurate, timely and consistent coding and DRG/code validation, while adhering to published coding guidelines and Company policy
• Actively reviews and manages data outcomes to identify root causes of coding quality issues for overall coding quality improvement
• Works in partnership across various teams to communicate production coding related issues such as workflow processes, forecasting, scheduling, quality activities, etc.
• Coaches and helps develop team members; helps resolve dysfunctional behavior within functional area(s); disciplines and counsel staff as necessary
• Proactively manages (including corresponding communications and escalation paths) significant issues in coding operations (e.g., productivity, TAT, quality), status of projects, barriers and successes
• Actively manages and monitors coding and clinical documentation improvement reconciliation operations
• Selects, evaluates, trains, and provides leadership and direction to reporting staff
• Responsible for review and improvement of process and services
• Responsible for ensuring employee work schedules sufficiently meet those requirements as established by the Leadership team
• Facilitates problem solving and collaboration within functional area(s)
• Works closely with other members of the Leadership Team in addressing issues related to accurate/timely coding, DRG/code validation, documentation, and unbilled management
• Works closely with other team members to address issues related to unbilled management, denials, medical necessity, payment compliance
• Responsible for ensuring staff compliance with documented and established workflow guidelines as it relates to adding and re-assigning accounts to work queues
• Coordinates and/or performs quality reviews of all direct reports’ work
• Assists in the development of strategy, specific goals, objectives, budgets and performance standards for the coding, DRG/code validation and clinical documentation improvement operations
• Assists in identifying and implementing process improvements to decrease costs, increase accuracy and improve service for applicable stakeholders
• Coordinates and/or performs productivity monitoring and provides timely and consistent feedback to employees and Coding Director
• Coordinates and/or prepares coding and DRG/code validation benchmarking, productivity, quality, and reports for the Coding Director and Facility Leadership
• Promptly reports issues or trends to the appropriate member of the Leadership team, or other appropriate party
• Maintains up-to-date knowledge of regulatory changes impacting coding requirements and ensures staff are appropriately educated
• Reviews all official data quality standards, coding guidelines, Company policies and procedures, and clinical/medical resources to assure coding knowledge and skills remain current
• Ensures employee compliance with Company educational requirements
• Coordinates work assignments
• Ensures safe work practices are being followed
• Coordinates training and education for all direct reports.
• Facilitates and/or participates in multi-disciplinary teams in addressing issues related to coding and clinical documentation improvement opportunities (as applicable)
• Practices and adheres to the “Code of Conduct” philosophy and “Mission and Value Statement”
• Other duties as assigned

Minimum Qualifications:

Education: Bachelor's degree in HIM/HIT required.

Experience: 7 years recent inpatient/outpatient hospital coding experience (production, auditing and or managing) required. 3 to 5 years of progressive leadership experience in healthcare required. Experience managing a large coding pool or coding review pool strongly preferred.

License(s)/Certification(s)/Registration(s) Required: RHIA, RHIT, CPC, or CCS required.

Knowledge, Skills and Abilities:

• Coding Technical Skills- extensive regulatory coding (ICD-10-CM, ICD-10-PCS, CPT/HCPCS, MS-DRGs, APR DRGs) and associated reimbursement knowledge.
• Case Mix Index Analytical Skills – ability to analyze trends in CMI and determine root cause and address as appropriate.
• Leadership - leads individuals and groups toward identified outcomes, setting high performance standards and delivering quality services.
• Critical Thinking - actively and skillfully conceptualizing, applying, analyzing, synthesizing or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning or communication as a guide to belief and action.
• Building and Maintaining Strategic Working Relationships – develops collaborative relationships to facilitate the accomplishment of work goals. Possesses excellent interpersonal skills in building, negotiating and maintaining crucial relationships.
• Building Trust – interacts with others in a way that gives them confidence in one’s intentions and those of the organization.
• Effective Operational Decision Making - relating and comparing; securing relevant information and identifying key issues; committing to an action after developing alternative courses of action that take into consideration resources, constraints, and organizational values.
• Adaptability – maintaining effectiveness when experiencing major changes in work tasks or the work environment; able to adapt to change in environment and/or circumstances with a positive outlook; and adjusting effectively to work within new work structures, processes, requirements, or cultures.
• Initiative – independently takes prompt proactive steps towards problem resolution.
• Managing Conflict – dealing effectively with others in an antagonistic situation; using appropriate interpersonal styles and methods to reduce tension or conflict between two or more people.
• Energy – consistently maintaining high levels of activity or productivity; sustaining long working hours when necessary; operates with vigor, effectiveness, and determination over extended periods of time.
• Stress Tolerance – maintaining stable performance under pressure or opposition; handling stress in a manner that is acceptable to others and the organization.
• Planning and Organization - proactively prioritizes initiatives, effectively manages resources and keen ability to multi-task.
• Communication - communicates clearly, proactively and concisely with all key stakeholders.
• Customer Orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
• Work Independently – is self-supporting; not needing to rely on others to complete a job.
• Facilitation – ability to facilitate small to large groups of people at various organizational levels for purposes of planning, problem solving, or strategy development.
• Quality Orientation – accomplishing tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.
• PC Skills - demonstrates proficiency in Microsoft Office applications and others as required.
• Policies & Procedures - articulates knowledge and understanding of organizational policies, procedures and systems
• Project Management - assesses work activities and allocates resources appropriately.
• Coach, Mentor and Educate – provides timely guidance and feedback to help strengthen the knowledge/skill set of others to accomplish a task or solve a problem.
• Work Independently – is self-supporting; not needing to rely on others to complete a job.

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OU Health is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more. We know that a total benefits and compensation package, designed to meet your specific needs both inside and outside of the work environment, create peace of mind for you and your family.