General Summary of Position
Collaborates within a system-wide multi-disciplinary team approach to achieve coding quality to help facilitate the precise representation of a patient's clinical status via assigned codeset. Provides guidance, oversight, and management in Coding Quality in collaboration with revenue cycle and clinical quality teams. Assists in developing and implementing system-wide strategies related to coding quality to ensure all information is accurately documented, coded and abstracted, and in full compliance with applicable rules. Leads coding quality review processes, both internal and with outside vendors, to review & improve coding accuracy as well as provide constant feedback on coding quality & learning opportunities. Collaborates with the Clinical Documentation Integrity Director related to documentation, coding, and regulatory compliance. Plays a key role in working with Clinical Documentation Integrity Director and CDI Physician Advisor regarding documentation requirements to support coding quality and development initiatives. Assists in the operational efforts related to reporting and tracking of quality measures initiatives (MHAC, PSI, HCC, PPC, Vizient, & Elixhauser risk models). Provides expertise in identification of subsequent optimization and maintenance projects and initiatives.
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Primary Duties and Responsibilities
Collaborates on system-wide multi-disciplinary team approach to achieve coding quality excellence to help facilitate the precise representation of a patient's clinical status to accurately reflect the patient's severity of illness and quality of care. Develops strategy for internal Quality Reviews to maximize coding. Directly supervises, manages and is responsible for daily workflow of Inpatient and Outpatient Quality Review Managers and Coding Quality Review Team. Works closely and monitors all work related to Coding performed by external vendors/auditors (ie. Accuity, Triage, Horizon, Deloitte). Develops internal processes to maximize external vendors findings and recommendations to optimize future work performed by MedStar Coding and Coding Quality Works closely with leadership from CDI, Coding Operations, Information Systems and IT Applications to evaluate new technology (for example: Computer Assisted Coding, physician communication applications) to help facilitate and streamline coding quality Works closely with Information Systems to ensure integrity of all data elements related to revenue and governmental reporting. Works closely and strategizes with Revenue Management and Reimbursement Department to monitor changes in reimbursement methodology (ie.DRG changes, NCD edits). Works with Revenue Management and Reimbursement Team to provide the necessary information and changes to DRG mapping to assist in the General Equivalency mapping (GEM) as well as new regulatory changes and HSCRC changes. Works closely with Revenue Management and Reimbursement Department for HSCRC audits as related to Coding and Abstracting. Assists in the ongoing DRG audit and analysis process as needed and collaborates as needed with CDI and Coding Operations Directors to provide expertise and support. Works closely with Compliance to ensure all activities related to Coding Quality are following federal, state and payer-specific billing requirements. Works closely with Quality and Physician Leadership on quality measures (MHAC, PSI, Mortality, Core Measures) as it relates to requirements for documentation and clinical support of appropriate DRG assignment. Provides guidance on the ICD-10-CM Official Guidelines for Coding and Reporting and compliance regulations. Works with Patient Financial Services to identify reimbursement issues, ensuring that claims, denials, and appeals are efficiently processed and to develop process improvement to minimize future issues. Makes recommendations to leadership on external vendor processes involving Coding Quality to maximize expert support within Coding and associated areas. Develops and contributes to the achievement of established department goals and objectives and adhere to department policies, procedures, quality standards and safety standards. Ensures compliance with hospital/facility policies and procedures and governmental/accreditation regulations. Maintains ongoing communication with HIM, Director of Coding Operations, Clinical Documentation Improvement Leadership, Compliance, and Physician Advisors at each business unit to review programs, provide feedback, discuss new developments, and exchange information. Participates in multidisciplinary quality and service improvement teams as appropriate. Participates in meetings, serves on committees, and represents the department and hospital/facility in community outreach efforts as appropriate. Works with business unit leadership to develop policies, procedures and performance standards related to Coding and Coding Quality programs.
Minimum Qualifications
Education
- Bachelor's degree in Health Information Management or related healthcare area. required or
- additional experience can substitute for education
Experience
- 5-7 years Coding management experience in an acute care hospital setting and demonstrated experience in developing standardized processes, procedures and policies that positively impact efficiencies and demonstrated training/education experience. required
- One year of relevant professional-level work experience may be substituted for one year of required education.
Licenses and Certifications
- RHIT - Registered Health Information Technician Upon Hire required or
- RHIA - Registered Health Information Administrator Upon Hire required and
- CCS-Certified Coding Specialist Upon Hire required and
- AHIMA ICD-10 Trainer Certif - ICD-10 Upon Hire preferred and
- Certified Project Management Professional (PMP)-PMI Upon Hire preferred
Knowledge, Skills, and Abilities
- Superior written, organizational, and presentation skills.
- Superior interpersonal skills with management, users, customers, and coworkers.
- Strong interpersonal communication skills to effectively interface with internal/external customers and senior management.
- Knowledge of coding and documentation compliance related to CMS and other regulatory agencies.
- Demonstrated ability to lead system-wide coding initiatives in a corporate setting including coding, training, clinical documentation, and quality review practices.
- Demonstrated knowledge of Patient Accounting, Patient Access and other related Revenue Cycle areas.
- Knowledge of the conventions, rules and guidelines for multiple classification systems.
- Knowledge of coding and operational implications of ICD-10.
- Knowledge of multiple reimbursement systems.
- Versatile computing skills.
This position has a hiring range of $131,497 - $256,630
