||Job SummaryThe role of this position is to develop and execute a strategic plan to operate an Enterprise Revenue Cycle Coding Department for NLH and all its member affiliates. This position contributes to the financial strength, compliance and overall performance by serving in a directional capacity for all coding functions. This position serves in a key role to monitor and facilitate improvement inthe overall quality, timeliness, completeness, and accuracy of coding processes (such as ICD-10-CM & PCS, CPT, E/M, Modifier application, MS-DRG & APR-DRG Grouping, and physician queries), as well aseffectiveness of Coding policy, practices and technology platforms for all NLH organizations.This Manager level position will focus on System-wide process, technology, controls and key personnel that must be coordinated to achieve coding, documentation integrity, compliance, and customer satisfaction.The enterprise manager will provide a leadership role in developing a model that integrates efforts to align coding practices in a timely, accurate fashion enterprise wide. This position will incorporate the organization's mission, vision and values into all staff development practices and all departmentally directed activities. The position will provide overall administration, direction, coordination, and evaluation of the Coding services within the NLH enterprise and is specifically responsible for the following:·Assignment of MS-DRG, ICD-10 Diagnoses & Procedures, POA, CPT (E/M & HCPCS), Modifier, and Discharge Disposition codes to established benchmarks by AHIMA and AAPC·Application of 1995 and 1997 documentation guidelines within our primary and specialty care settings·Developing audit schedules and determining focus,in conjunction with Enterprise Quality Manager, for Enterprise External Coding Validations·Analysis of Coder productivity and working in conjunction with the Enterprise Quality Manager on action plans·Track coder certifications and continuing education fulfillment·Hiring and employee evaluations for all coding positions·Supporting Clinical Documentation Improvement efforts and adherence to Official Coding Guidelines·Escalation of medical group accounts outside of timely documentation threshholds impacting charge capture and final coding·Tracking physician queries and TAT as well as quality of written query·DNFC reporting and action plans·Manage contract coding support·Fostering collaborative relationships with medical group leaders in support of coding functionsIt is critical that this position be highly effective in delivering the services described above and work harmoniously with leaders and staff across NLH.Effectiveness will be measured in terms of results, commitment to NLH and customer satisfaction (at all levels).This leader will work collaboratively with Revenue Integrity, Patient Financial Services, Compliance, HIM functional managers, CDI leaders, and physician leaders.NLH is committed to the highest standard of patient and family centered care and employee and faculty engagement.Staff will serve as role models by practicing exemplary behaviors when working with patients, visitors, and fellow staff members.Education and Experience·Health Information Technology or Health Information Administration degree preferred;at least 8 years of progressive, relevant knowledge toward mastery in the field accepted in lieu of degree·5+ years of progressively responsible management level experience requiredLicenses or Certifications·Registered Health Information Administrator/Registered Health Information Technician Preferred·Coding Certification required (CCS, CPC, COC, CCS-P).Required Minimum Knowledge, Skills and Abilities
·Working knowledge of Medical Record, Health information, and Healthcare Application technology.·Demonstrated experience in diagnosing, evaluating and developing corrective actions for problems in Coding operations.·Able to proactively make appropriate changes in the coding operations to position NLH for healthcare reform and competition.·Able to effect collaborative alliances and promote teamwork.·Effective organizational, planning, controlling, scheduling and project management abilities.
- Detailed knowledge of privacy and security regulations, confidentiality / HIPAA
- Payer specific coding requirements
- Working knowledge of Official Coding Guidelines, Medical Terminology, Classification Systems: ICD-10-CM/PCS, MS-DRG, APR-DRG, DSM and Terminologies:CPT/HCPCS, E/M
- Knowledge of sources for local and national review policies impacting coding
- Ability to analyze PEPPER report data and develop coding action plans
- Effective managerial and administrative abilities as applied to the management of multiple projects.
- Effective leadership abilities.
- Ability to positively influence change.
- Excellent communications skills, both oral and written.
- Demonstrated ability to work well with diverse people, excellent human relation skills.
- Flexible and able to react to ever changing priorities.
- Ensure effective communication and coordination with other functional areas to achieve desired service levels.
- Collaborates with medical records, and clinical documentation improvement areas to ensure that record completion processes are working effectively.
- Communicates with other system Managers to establish accountability and coordination between HIM and other system departments/operations.
- Work collaboratively with departmental personnel to implement systems and process change aimed at improving Coding departmental performance.
- Oversee provider education related to documentation practices that support accurate reporting of coded data.
- Directly manages all coding personnel including hiring, payroll, performance evaluations, and disciplinary action when appropriate.
- Provide strategic direction and oversee the operation and process design of systems and procedures to ensure efficient functioning of Coding operations across all NLH organizations.
- Develop, monitor and manage operations utilizing industry metrics on a monthly, annual and long-range planning basis.Develop metric report cards to quantify improvements in productivity, quality, service and overall financial results.
- Active participation in Denial Mitigation and revenue preservation activities.
- Representation, tracking, and resolution of 3rdparty audits i.e. RAC Audits.
- Participates in drafting and final approval processes for Coding policies and procedures.
- Evaluate appropriate and key outsourcing partnerships such as coding assistance, and documentation auditing, etc.
- Monitor and support daily staff functions in all areas related to the scope of the Manager's responsibility.
- Ensure strong technology functionality to support all elements of Coding as it relates to revenue cycle and interfaces with clinical and other operational areas
- At the direction of the Associate Vice President of HIM, provides formal reports and presentations to management teams, physician groups, NLH affiliated members, external business and consumer groups.
- Assist with special analysis and projects as needed.
- Seek and recommend new information technology solutions and or manual changes that support Coding departmental functions.
- Serve to coordinate integration of meaningful use, population health, and the EMR applications across NLH enterprise.
- Ensure development of industry best practice operating procedures with consistent application in all business units.
- Maintain compliance standards for providing accurate information on all hospital and provider activities in coordination with corporate compliance officer.
- Review and analyze on-going Coding KPI's based on computer generated data and manual reports.
- Achieve annual and periodic goals and key performance indicators in support of Coding and Revenue Cycle operations and overall financial performance.
- Manage, prepare and present budgets that demonstrate prudent use of the organization's resources.Achieve planned results for Coding operations.
- Ensure effective coordination with NLH Associate Vice President of HIM to achieve financial and service level goals for the Coding business units as well as the Enterprise.
- Enterprise responsibility for managing the DNFC (Discharged Not Final Coded) with identification of problem areas and action plans to address.
Community·Collaborate with local area colleges on placement of interns focused on coding certification programs and site experience for health information technology programs.·Share enterprise knowledge on coding operations through state association meetings and local chapter meetings.*Perform other duties as assigned.Organizational ValuesPassion:We demonstrate a passion for caring for others and the pursuit of service excellence in all that we do.Integrity:We commit to the highest standards of behavior and doing the correct thing for the right reasons.Partnership:Working together in collaboration and teamwork is more powerful than working alone.Accountability:We take a responsible and disciplined approach to achieving our priorities and responding to an ever changing environment.Innovation:We are capable of extraordinary creativity and are willing to explore new ideas to achieve our healthcare mission.Respect:We respect the dignity, worth and rights of others.Safety Requirements·Assist in maintaining a work environment free from recognized hazards that create a risk or injury to employees, patients, or visitors·All accidents and incidents are reported by employees within 24 hours and supervisor to submit properly investigated report timely·Ergonomic evaluations are completed as needed·When appropriate, assist and support with the return of all workers with work related injuries and illness to gainful employmentPhysical Demands·Sedentary:Exerting up to 10 lbs. occasionally, sitting most of the time, and only brief periods of standing and walking.·Requires the ability to travel to member organizations as neededTravel Requirements:·15 – 50% travel may be required.·Employee must have a valid drivers' license and possess own transportation.Note: the duties listed above reflect the majority of the essential duties of this job and does not, nor is it intended to, reflect all essential duties that may be required for an incumbent in this job to perform.
Equal Opportunity Employment
We are an equal opportunity, affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status.
- Serves as subject matter experton coding functions including ICD-10 & CPT application, E/M bell curve analysis, Severity & Mortality impacts, HCC Diagnosis capture, DRG validation, and identification of prebill coding review opportunities
- Direct ongoing programs for staff development and training that foster and mentor the next generation of coding leaders.
- Work closely with operational directors and managers to identify common areas of deficiencies and create training to correct the noted deficiencies.
- Working closely with the Associate Vice President of HIM to assess, design, and implement government regulated documentation and coding requirements such as ICD-10, CPT, etc.
- Attend local, regional and national conferences/seminars to remain current in supporting the needs of Coding activities.
- Review industry publications to maintain knowledge base concerning Coding classification systems and guidelines.
- Maintain current knowledge of regulatory developments involving agencies (CMS, AHA, DHS, and Joint Commission.)
- Maintain certifications (RHIA, RHIT, CPC, etc.)
- Maintain membership with professional associations (HFMA, AAHAM, AAPC, AHIMA, ACDIS, Etc.)