Responsible for directing all centralized coding functions, including quality, productivity, coder training/education, physician onboarding/education and failed claims . Position also responsible for supporting Central Billing Office as necessary regarding Claims Processing issues as it relates to coding. This position is responsible for the development of coding guidelines in accordance with the most recent published regulations from CMS, AMA, ACOS, AHIMA, and The Official Coding Guidelines. They are accountable for the coordination of any new inpatient, outpatient or professional payment methodology impacting coding, abstracting, and hospital or professional reimbursement.
The HIM Coding Director acts as liaison with other departments/practices to support coding of new services/practices. They will have operational responsibilities within Revenue Cycle and have interactive relationships with Sr. Leadership, Physicians and Providers throughout the network. They will work collaboratively with the VP Revenue Cycle to develop and deploy strategy that supports the mission, vision, and values of the organization.
SCOPE OF POSITION
- This position reports to the System Director of Coding. This position manages 5 subordinate Manager(s) who supervise(s) a total of 109 associates (FTE’s) in the HIM Coding and OPG Coding department(s). This position also directly supervises 2 non-supervisory associate(s).
- The director will have key responsibilities that will include, at a minimum, breakthrough/goal deployment, development and execution, execution for coding services and educational programs, process improvement and ongoing development and talent management for the Facility & Professional Coding Departments.
- This position is responsible for the overall direction, coordination, and evaluation of these units and carries out managerial responsibilities in accordance with the organization’s policies and applicable laws. Responsibilities include interviewing, hiring, and training associates; planning, assigning, and directing work; appraising performance; rewarding and disciplining associates; addressing complaints and resolving problems.
- Annual combined operational budget (if applicable): $12.8 Million
MAJOR DUTIES/RESPONSIBILITIES & ESSENTIAL FUNCTIONS
- Coordinates and manages centralized coding and abstracting functions
- Oversees coding functions by establishing common guidelines/processes and updating these as clinical and financial processes change.
- Major goals include: accuracy of coded data, efficiency and productivity of coding team and integration of processes and guidelines at all sites to meet DNFB and A/R organizational financial targets.
- Provides guidance to the failed claims team who works internal failed claims and also works with departments regarding medical necessity issues to ensure documentation supports medical necessity.
- Problem-solves with departments to ensure processes are in place to address issues.
- Assists with processes requiring intervention as indicated throughout the billing/coding process.
- Ensures compliance with Revenue Cycle targets for resolution of failed claims.
- Coordinates billing/coding activities with Revenue Cycle and A/R representatives (CBO, Patient Access, and Customer Service) and participates in problem-solving.
- Works with practice managers to ensure timely and accurate capture of all charges for coding and oversight of guideline for OPG practices.
- Monitors Coder & Physician audit results to maintain quality of information at all campuses/practices.
- Maintains current information on governmental regulation changes, especially ICD-9 CM, CPT-4 and HCPCS coding, and RVU, APC and DRG updates affecting coding, staffing, and hospital/professional reimbursement.
- Oversees HIM & OPG budget for coding operations ($12.8M).
- Conducts staff evaluations and disciplinary actions as necessary at all campus locations.
- Hires and/or fires any direct reporting positions.
- The major duties/ responsibilities and essential functions listed above are not intended to be all-inclusive of the duties, responsibilities and essential functions to be performed by associates in this job. The associate is expected to all perform other duties as requested by supervisor.
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