Inpatient Coding & Clinical Documentation Improvement Manager

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  Responsible for the management and strategic direction of the hospital billing inpatient coding and clinical documentation improvement teams. This position has shared responsibility to achieve the business unit goals in targeted areas such as unbilled accounts receivable, compliance with regulatory requirements, coding data accuracy and reimbursement from third party payors. Responsible for budget preparation and oversight; hiring, disciplining, and terminating employees; staff development to ensure this department meets the service needs of the organization as follows:

  
  
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  Interview, hire, orient, review and discipline employees.

  
  
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  Conduct employee performance evaluations and reviews, annual salary review, and performance documentation and discussion.

  
  
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  Coordinate and prioritize inpatient coding and CDI work flow.

  
  
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  Oversee the scheduled work hours; monitor staffing, time cards, overtime, vacations, and time off.

  
  
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  Conduct appropriate departmental staff meetings.

  
  
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  Ensure new employee training is completed and training for all employees is current and ongoing.

  
  
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  Assist employees in solving problems as necessary.

  
  
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  Monitor and recommend staffing levels.

  
  
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  Monitor accuracy, efficiency and productivity of all inpatient coding personnel to ensure compliance with departmental performance standards.

  
  
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  Develop and maintain budget for the hospital billing coding and CDI department

  
  
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  Develop and maintain all policies and procedures pertaining to the Clinical Documentation Improvement Program, inpatient coding and the specific duties related to each of these areas

  
  
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  Build a cohesive team by establishing clear direction, goals and responsibilities. Supports the team's success by providing necessary resources and breaking down barriers. Creates an environment which fosters motivation and builds commitment.

  
  
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  Ensure compliance of, and proper coding procedures are adhered to as defined by CMS regulations, Local Medicare Carrier Review Policies (LMRP), Local Carrier Determinations (LCD), the AMA any applicable HCMC compliance policies, as well as any relevant accrediting and payer organizations.

  
  
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  Develop long range plans for work teams' activities and monitor results to ensure compliance with expectations for Clinical Documentation Improvement and Inpatient Coding functional areas

  
  
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  Abstract and compiles data that contribute to measuring and improving provider medical record documentation. Designs, prepares, and distributes meaningful reports using multiple databases.

  
  
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  Manage audit processes of medical record documentation and facilitates monitoring, tracking, and trending of audit results. Collect and organize data from multiple sources such as Epic, Doc-MS, departmental databases, etc. Communicate audit results to identified and appropriate audiences.

  
  
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  Develop, implement, and maintain quantity and quality performance improvement standards and monitors the quality and quantity of work produced by the clinical documentation specialists and inpatient coders

  
  
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  Participate in the development of the Clinical Documentation Improvement and Inpatient Coding strategy and manages the supporting projects under the guidance of the Health Information Management Director and the Assistant Medical Director of Documentation Quality to ensure timely completion deadlines.

  
  
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  Coordinate education to providers regarding overall documentation and coding requirements for inpatient records. This will include elements for complete documentation availability, documentation integrity, provider fee billing, compliance, patient profiling and facility coding/billing.

  
  
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  Implement strategies to address audits results that identify areas of opportunity related to physician documentation to minimize risk related to external auditors (ex: RAC, MIC, ZIP, etc.) regarding quality, profiling, coding and reimbursement measures.

  
  
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  Lead the communication effort with physicians, physician leaders, administrative leaders, and other stakeholders regarding the progress, success, and opportunities of the program on a regular basis.

  
  
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  Works collaboratively as a key participant in the development and implementation of system enhancements and modifications of coding workflows.

  
  
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  Facilitate the collection of information to provide ongoing feedback to physician on work performance to ensure accuracy and consistency with all coding.

  
  
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  Assist Revenue Cycle management with the development and implementation of administrative policies, procedures and guidelines for departmental operations. Responsible for periodic evaluation of operational processes to assess relevancy to changing goals and objectives of the department.

  
  
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  Manage the PSI/HAC review program in conjunction with Quality Performance Department

  
  
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  Coordinates the escalation of documentation queries and issues to Physician Liaison's as needed.

  
  
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  Work with clinical department physician chairmen to obtain timely completion of queries and provide physician education.

  
  
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  Develop and plan educational programs to providers about quality documentation, ICD coding, profiling and hospital metrics.

  
  
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  Facilitate the resolution of coding documentation issues and DRG mismatches.

  
  
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  Performs other duties as assigned.

  
  

Preferred Qualifications:

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  Master's Degree in Nursing or other healthcare field

  
  

Knowledge/ Skills/ Abilities:

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  Experience with Epic electronic medical record functionality and 3M Coding Reimbursement products recommended

  
  
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  Knowledge of state and federal legislation for HIPAA Privacy, medical record access, and regulatory and accreditation agencies; retention of medical records; storage and retrieval systems,

  
  
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  Knowledge of current medical record technology, statistics, data presentation and reporting;

  
  
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  Knowledge of budget preparation and management;

  
  
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  Knowledge of project management and performance improvement.

  
  
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  Ability to communicate effectively with all levels of the organization and within the health care community;

  
  
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  Communicate effectively in oral or written communications; initiate, lead, mentor and coach staff;

  
  
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  Develop and implement policies and procedures;

  
  
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  Organize, delegate and monitor work assignments;

  
  
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  Demonstrated proficiency in the ability and desire to develop positive working relationships with physicians and other professional health care staff.

  
  
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  Strong broad-based clinical knowledge and understanding of pathology/physiology.

  
  
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  Excellent written and verbal communication skills and critical thinking skills.

  
  
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  Working knowledge of overall documentation requirements

  
  
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  Excellent data analysis and process evaluation skills

  
  
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  Working knowledge of Medicare reimbursement system and coding structures

  
  

Leadership Knowledge/ Skills/ Abilities:

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  Ability to effectively manage company resources (i.e. budget and personnel)

  
  
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  Skilled in overseeing the efforts of high-level department individuals

  
  
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  Superb ability to motivate employees and inspire positive change within department

  
  
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  Innovative thinker; Ability to contribute new ideas that support organizational goals

  
  
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  Skilled in managerial duties (i.e. hiring, firing, performance appraisals, pay reviews)

  
  
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  Skilled in modeling company values through daily interactions within the department, particularly with regards to health and safety

  
  
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  Capable of supporting the work of the department

  
  
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  High standard of ethics, discipline, and professionalism

  
  
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  Skilled in fostering a positive workplace culture and building inclusive workplace teams

  
  

License/Certifications:

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  Certified Clinical Documentation Specialist (CCDS), Clinical Documentation Improvement Practicioner (CDIP), Registered Health Information Administrator (RHIA) or Registered Health InformationTechnician (RHIT)