Inpatient Coding and Clinical Documentation Improvement Manager
4 weeks ago
We are seeking a highly skilled Inpatient Coding and Clinical Documentation Improvement Manager to join our Middle Revenue Administration team. This full-time role will primarily work remotely and will be responsible for leading the coordination and collaboration of health information, inpatient clinical documentation, and inpatient coding within the HCMC system.
Key Responsibilities- Manage and lead the inpatient coding and clinical documentation improvement teams to achieve business unit goals in targeted areas such as unbilled accounts receivable, compliance with regulatory requirements, coding data accuracy, and reimbursement from third-party payors.
- Develop and maintain budget for the hospital billing coding and CDI department.
- Develop and maintain all policies and procedures pertaining to the Clinical Documentation Improvement Program, inpatient coding, and specific duties related to each of these areas.
- Build a cohesive team by establishing clear direction, goals, and responsibilities, and providing necessary resources and breaking down barriers.
- 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, and any applicable HCMC compliance policies, as well as any relevant accrediting and payer organizations.
- 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.
- Abstract and compile data that contribute to measuring and improving provider medical record documentation, and design, prepare, and distribute meaningful reports using multiple databases.
- Manage audit processes of medical record documentation and facilitate monitoring, tracking, and trending of audit results.
- Develop, implement, and maintain quantity and quality performance improvement standards and monitor the quality and quantity of work produced by the clinical documentation specialists and inpatient coders.
- Participate in the development of the Clinical Documentation Improvement and Inpatient Coding strategy and manage the supporting projects under the guidance of the Health Information Management Director and the Assistant Medical Director of Documentation Quality.
- Coordinate education to providers regarding overall documentation and coding requirements for inpatient records, including elements for complete documentation availability, documentation integrity, provider fee billing, compliance, patient profiling, and facility coding/billing.
- Implement strategies to address audit results that identify areas of opportunity related to physician documentation to minimize risk related to external auditors (e.g., RAC, MIC, ZIP, etc.) regarding quality, profiling, coding, and reimbursement measures.
- 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.
- Work collaboratively as a key participant in the development and implementation of system enhancements and modifications of coding workflows.
- Facilitate the collection of information to provide ongoing feedback to physicians on work performance to ensure accuracy and consistency with all coding.
- Assist Revenue Cycle management with the development and implementation of administrative policies, procedures, and guidelines for departmental operations, and responsible for periodic evaluation of operational processes to assess relevancy to changing goals and objectives of the department.
- Manage the PSI/HAC review program in conjunction with Quality Performance Department.
- Coordinate the escalation of documentation queries and issues to Physician Liaison's as needed.
- Work with clinical department physician chairmen to obtain timely completion of queries and provide physician education.
- Develop and plan educational programs to providers about quality documentation, ICD coding, profiling, and hospital metrics.
- Facilitate the resolution of coding documentation issues and DRG mismatches.
- Bachelor's degree in nursing, business, and/or healthcare administration, health information management, or health information technology.
- Three (3) years of healthcare management experience with supervisory/management responsibilities.
- Three years of experience working with documentation to meet quality, financial, and regulatory requirements.
- Master's degree in nursing or other healthcare field.
- Experience with Epic electronic medical record functionality and 3M Coding Reimbursement products recommended.
- 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.
- Knowledge of current medical record technology, statistics, data presentation, and reporting.
- Knowledge of budget preparation and management.
- Knowledge of project management and performance improvement.
- Ability to communicate effectively with all levels of the organization and within the healthcare community.
- Ability to communicate effectively in oral or written communications; initiate, lead, mentor, and coach staff.
- Ability to develop and implement policies and procedures.
- Ability to organize, delegate, and monitor work assignments.
- Ability to demonstrate proficiency in the ability and desire to develop positive working relationships with physicians and other professional healthcare staff.
- Strong broad-based clinical knowledge and understanding of pathology/physiology.
- Excellent written and verbal communication skills and critical thinking skills.
- Working knowledge of overall documentation requirements.
- Excellent data analysis and process evaluation skills.
- Working knowledge of Medicare reimbursement system and coding structures.
- Ability to effectively manage company resources (i.e., budget and personnel).
- Skilled in overseeing the efforts of high-level department individuals.
- Superb ability to motivate employees and inspire positive change within the department.
- Innovative thinker; ability to contribute new ideas that support organizational goals.
- Skilled in managerial duties (i.e., hiring, firing, performance appraisals, pay reviews).
- Skilled in modeling company values through daily interactions within the department, particularly with regards to health and safety.
- Capable of supporting the work of the department.
- High standard of ethics, discipline, and professionalism.
- Skilled in fostering a positive workplace culture and building inclusive workplace teams.
- Certified Clinical Documentation Specialist (CCDS), Clinical Documentation Improvement Practitioner (CDIP), Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT).
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