Director, Medical Coding

PURPOSE OF POSITION:

Implements and supports the strategic vision for CCHC Medical Coding Operations across all entities. The Director of Medical Coding will plan, organize, and manage the coding units across the system. The Director will ensure that accurate, coded data exists for optimal reimbursement by the organization, and coordinate all quality and compliance monitoring of assignments for hospital and professional technical services.

PRIMARY DUTIES AND RESPONSIBILITIES:

• Oversees the daily operations of the coding unit including workload and staffing; hiring, disciplining, and performance appraisals; training; and monitoring quality of work.
• Develops long-range and short-term goals, objectives, plans, and programs and ensures they are implemented.
• Assists in planning, developing, and controlling the budget, including staffing costs, capital equipment, and operations of the coding unit.
• Lead the establishment and implementation of Key Performance Indicators (“KPIs”) for coding functions. Responsible for measurement and reporting of ongoing financial and operational performance. Ensure the implementation of action plans where performance is not meeting expectations; review KPI expectations annually and adjust appropriately. Recognize areas of excellence.
• Develop, implement, and oversee effective and consistent operational policies, processes, tools, and educational materials within all coding functional areas.
• Ensure coding staff across all functions comply with established policies, processes and quality assurance programs.
• Oversee, measure, and report ongoing financial and operational performance of coding operations across CCHC.
• Identify potential process improvements throughout coding functions, and lead design and implementation as required.
• Maintain an up-to-date knowledge of regulatory and compliance changes impacting Coding requirements and operations, and ensure coding employees are appropriately educated and processes are modified as needed.
• Ensure that the confidentiality of medical information is maintained across the health system and that use of the records and release of information is in accordance with policies and applicable laws without detriment to immediate patient care, including third party payors.
• Monitor and facilitate service level agreements (“SLAs”) between coding operations and other related functions within both Revenue Cycle and Clinical operations.
• Coordinate with peers and applicable stakeholders across the revenue cycle organization on the management of coding-related billing edits and third-party denials by working with Denial Management to identify trends and implement denials prevention and/or recovery program.
• Build strong relationships and facilitate productive communication between key Revenue Cycle stakeholders, including peer leaders of Revenue Cycle services and core support departments (e.g., human resources, IT, finance, etc.).
• Responsible for reviewing and monitoring the Discharged Not Billed (“DNB”) and working with key constituents to develop strategies to resolve outstanding issues and enable desired DNB performance metrics to be met.
• Support CCHC strategic initiatives that require involvement from coding areas as required.
• Assess direct reports performance on a consistent basis and provide feedback to reward effective performance and enable proactive performance improvement steps to be taken.
• Serves as the Chair of the Unbilled Committee. Serves on other committees as required.
• Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers.
• Challenges current working practices; identifies process improvement opportunities and presents recommendations and solutions to management. Engages and commits to the organization’s culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence.

EDUCATION/EXPERIENCE/TRAINING:

• Bachelor degree in Business Administration, Healthcare Management or related discipline and or the equivalent experience. Master’s degree preferred.
• Minimum of five to seven years of relevant experience with a track record of progressively responsible positions in a complex healthcare organization such as a multi-hospital system, large group practice or a major healthcare consulting firm preferred. Minimum of three to five years of supervisory/management experience.
• One of the following certifications required (RHIA, RHIT, CPC, or CCS).
• Evidence of successful Discharged Not Billed (DNB) management.
• Strong working knowledge of billing and collection processes and functions and general revenue cycle management strategies, as well as industry best practices.
• Thorough knowledge of metrics, analytics, and data synthesis in Health Information Management and revenue cycle management to identify trends, produce reliable forecasts and projections.
• Strong analytical and critical thinking, organizational, and business process optimization skills, with in-depth ability to develop and pursue goals, synthesize data to identify system vulnerabilities and develop and apply innovative solutions.
• Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
• An understanding of the psychology of complex corporate relationships, and an ability to influence within such an environment.
• Excellent communication, leadership, delegation, and interpersonal skills.
• Above average understanding of how, when, and to what extent different hospital departments relate to and communicate with one another.