Manager-Health Information Management Coding-Medical Records

Job Objective:

Manages hospital coding and charging activities within the scope of the Health Information Management (HIM) Department, including but not limited to Inpatient, Outpatient Surgery, Emergency and Trauma Department, Obstetrical Emergency, Observation, hospital-based services and diagnostic services. Responsible for day-to-day communication with vendors, managing Epic work queues/DNFC, investigating and completing coding updates and corrections, coordinating appeals, denials, and rebills. Serves as the HIM Epic and 3M Super-user for coding and charging.

Essential Responsibilities:

• Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations.
• Works closely with HIM Director and HIM Managers to support revenue cycle initiatives, including denials and appeals.
• Manages day-to-day coding responsibilities in accordance with established policies and Coding Compliance plan.
• Works closely with the hospital coding vendor to insure accounts are coded accurately and in a timely manner; identifies, investigates, and resolves barriers to coding; responsible for day-to-day communication with vendors, managing Epic work queues/DNFC, investigating and completing coding updates and corrections. Identifies potential missed opportunities for coding and charging.
• Collaborates with IT analysts to manage Epic and
• Serves as the HIM Epic Super-user for coding and charging.
• Manages the organization’s repository of coding query templates.
• Monitors for coding compliance, as well as disseminating information and education regarding coding topics.
• Manages HIM ER, trauma, and OB-ER charging workflows, assist with development of new/modified charges, assists with troubleshooting and investigating issues related to charges.
• Manages Epic Simple Visit Coding, including all coding related to lab and diagnostics; analyzes data and evaluates opportunities to expand usage.
• Receives, investigates, and resolves all patient complaints related to hospital coding issues.
• Manages and oversees coding audit activities and coding compliance initiatives; conducts data analysis and recommends action plans.
• Manages HIM’s role in coordinating appeals, denials, payer and RAC audits, rebills, hospital-acquired conditions (HAC), including review and analysis of payer and regulatory communications, performing chart review and account analysis, and making appropriate recommendations; communicates with third-parties and payers regarding coding issues.
• Facilitates and insures ongoing communication and feedback with Clinical Documentation Improvement team, including review of DRG mismatches.
• Collaborates with healthcare providers to clarify documentation for accurate code assignment.
• Responsible for all aspects of state-mandated coding data, including data upload, data analysis, and data correction; analyzes data and reports trends, issues, and educational opportunities to appropriate organizational leaders.
• Interacts with organizational leaders, medical staff, Clinical Documentation Improvement, Hospital and Clinic Billing offices, and others needing HIM coding support.
• Develops and maintains reports and educational materials.
• Collaborates with HIM Managers to facilitate documents required to complete coding and support departmental initiatives.
• Facilitates on-boarding and off-boarding of HIM vendor staff, new HIM employees, and students.
• Develops work schedules proficiently, changes in staffing roles and work assignments based on department needs; revises schedule to ensure effective coverage at all times, including working within department due to staffing shortage; participates in the interview and hiring process to ensure adequate staffing.
• Consistently demonstrates fair and effective management of department employees (i.e.: performs timely evaluations, initiates appropriate coaching/counseling, fair application of policies/procedures, implements mechanisms to ensure competent staff.); trains staff in core competencies and monitors progress toward meeting competencies; monitors productivity to ensure that productivity standards, quality standards and deadlines are met.
• Develops and provides training to staff on various aspects of the business in relation to Health Information Management areas of responsibility, such as documentation requirements, release of information and regulatory workflows, privacy and security, coding, charging, revenue integrity, and compliance.
• Maintains current AHIMA credentials, certifications, and carries out work duties in accordance with the AHIMA Code of Ethics.

Essential Skils:

• Ability to collaborate and communicate with all levels of leadership, medical staff, and patients
• Extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, charging, and billing
• Ability to manage complex initiatives and projects
• Ability to investigate and analyze multiple coding resources such as Coding Clinic, CPT Assistant, coding and charging for devices and implants, Local/National coverage determinations, and payer contracts
• Ability to prioritize tasks and manage time efficiently to meet deadlines
• Ability to adapt quickly to changing priorities and unexpected situations
• Ability to analyze issues, identify root causes, and develop solutions
• Ability to use Microsoft Office Suite (Word, Excel, Outlook, PowerPoint) and other relevant software applications
• Written and verbal communication skills
• Ability to create and maintain positive interpersonal relations with peers, staff, leaders and vendors
• Extensive working knowledge of revenue cycle workflows, charging, revenue integrity, and hospital accounting principles
• Ability to effectively communicate in a positive and professional manner
• Strong people skills to manage with influence and respect; ability to act as culture custodian to preserve a caring and collaborative environment
• Working knowledge of Epic workflows pertinent to HIM, coding, and revenue cycle
• Excellent self-management skills are required in order to manage multiple conflicting deadlines; due to the complexity of the business, effective delegation and working through the direct reports, as well as other departmental staff, are a must in order to deliver timely results
• Working knowledge of Health Information Department scope and workflows
• Expert knowledge of 3M encoder and related products
• Expert-level working knowledge of inpatient and outpatient coding guidelines, including ICD-10-CM/PCS and CPT