Manager of Coding at Crystal Clinic Orthopaedic Center, LLC in Akron, Ohio

Job Description:

Position Summary
Supervises and, as needed with contracted coding groups, provides training to ensure medical records are coded with accuracy and completeness in both Crystal Clinic Orthopaedic Center (CCOC) EMRs for Facility and Professional Fee coding. Manager will be responsible for reviewing, interpreting and abstraction/coding of all CCOC records according to standard classification systems; incumbent will perform the most advanced medical records coding and abstraction duties and will perform data quality review and will prepare complex reporting, as needed. Ensures medical records coding operations follow the latest guidelines and compliance standards. Maintains required documentation and confidentiality of patient records. Implements processes for coding operations that support the needs of Crystal Clinic providers in relation to coding education, questions and/or investigations. Develops and maintains up-to-date knowledge of the latest ICD and CPT coding versions and encoder and ensures the coding team(s) receive updates and training on classifications or guideline changes either from their company and/or via CCOC.

Essential Job Functions/Accountabilities
Manages and performs a wide range of activities pertaining to the review and coding of inpatient and outpatient medical record information. Subject matter expert of E/M facility and professional charging and coding for outpatient areas.

Establishes, implements and maintains a formalized review process for coding compliance, including a formal review (audit) process; designs and uses audit tools to monitor the accuracy of clinical coding.

Performs data quality reviews on inpatient records to validate the International Classification of Diseases Manual (ICD-10-CM), and other codes; verifies Diagnosis Related Group (DRG) group appropriateness; checks for missed secondary diagnoses and procedures and ensures compliance with all DRG mandates and reporting requirements; monitors Medicare and other DRG paid bulletins and manuals, and reviews the current Office of the Inspector General (OIG) work plans for DRG risk areas.

Performs data quality reviews on outpatient encounters to validate the ICD-10-CM, the Current Procedural Terminology (CPT), and the Healthcare Common Procedure Coding System (HCPCS) Level II code and modifier assignments; verifies Ambulatory Payment Classification (APC) group appropriateness; checks for missed secondary diagnoses and/or procedures; ensures compliance with all APC mandates and outpatient reporting requirements; monitors medical visit code selection against facility specific criteria for appropriateness; assists in the development of such criteria as needed.

Continuously evaluates the quality of clinical documentation to identify incomplete or inconsistent document for inpatient and/or outpatient encounters that impact the code selection and resulting APC/DRG groups and payment; brings concerns to the attention of the HIM Director and/or medical staff for resolution.

Provides or arranges for training of facility healthcare professionals in the use of technical coding guidelines and practices, proper documentation techniques, medical terminology and disease as they relate to the DRG, APC and other data quality management.

Maintains knowledge of current and required coding certifications as appropriate; may perform the most technical complex and difficult coding and abstraction work. Resolve complex coding discrepancies and identify risk-based areas of coding.

Selects, assigns, and trains coding team(s); directs, monitors and evaluates work; reviews and makes decisions regarding leave requests; initiates and implements disciplinary action as needed; assists with and promotes the recruitment and retention of qualified staff as assigned.

Assures the coding staff has a 95.5% accuracy rate in assigning ICD-10-CM and CPT codes and assure the coding staff has a 95.5% accuracy rate in assigning DRG codes. Assure that the coding staff follows all coding guidelines and implements a recheck of charts after physicians complete them to assure the codes match the final diagnoses. Resolve all discrepancies with the physicians and coders and re-bill if there is a payment difference. Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association; reports areas of concern to the Director of Health Information Management.

Assists the Director by serving as a facility representative for DRG/APC updates published in third-party payer newsletters, bulletins and/or provider manuals; shares information with facility staff as directed.

Stays informed about transaction code sets, Health Insurance Portability and Accountability Act (HIPPA) requirements and other future issues impacting health information management functions; keeps abreast of new technology in coding and abstracting software and other forms of automation.

Demonstrates and maintains competency in the use of computer applications, particularly the coding and abstracting software and hardware currently in use by the Health Information Management division. Monitors unbilled account reports for outstanding services or un-coded discharges to reduce accounts receivable days for inpatients and/or outpatients; performs periodic claim form reviews to check code transfer accuracy from the abstracting software and the charge master.

In partnership with appropriate personnel, recommends and implements standardized, organization-wide coding guidelines and documentation requirements; develops and implements training and educational programs for physicians and coders.

Consults with other divisions and individuals regarding data quality management.

Collects and prepares data for studies involving inpatient stays and outpatient encounters for clinical evaluation purposes; prepares and maintains a variety of complex records and reports. Conduct monthly meetings with Coding Team(s)/ consultant groups. Assist with the development and implementation of policies, procedures, standards, and initiatives. Supports new system implementations and system upgrades. Review and Respond to all FSC, DRG, BWC and Status Denials

Maintains a professional working relationship with internal/external customers. Maintains and enhances professional growth and development through educational programs, workshops, and professional affiliations.

All other duties not specifically assigned.

Position Requirements
Education: Associate or Bachelor's Degree in Health Information Management or Business, Health Administration required.

Experience: Minimum 3-5 years in a health care leadership role. 3 years of professional coding (E/M and surgical) experience required and 3 years of experience working as a Clinical Documentation Integrity specialist or a comparable position is preferred. Minimum of 3-5 years of management experience in a multi-facility, integrated health care delivery system, revenue cycle, or consulting experience preferred. Work experience in a hospital setting required, specialization in orthopaedics, preferred.

Technical Skills: Experience with medical record coding conventions (ICD-10-CM/PCS) and data analysis is required. Excellent interpersonal communication and organizational skills required to not only hire, train and manage employees but required for interactions with physicians, nursing staff, case managers and other hospital personnel. Strong critical thinking skills, and ability to assess, evaluate and teach members of the healthcare team. Knowledge and experience with medical information computer applications, word processing and electronic spreadsheets. Strong leadership, project management and communication skills.

Certifications/Licenses/Registrations: Must possess one of the following certifications: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Professional Coder (CPC) or Certified Coding Specialist (CCS). Additional Certifications: Certified E&M Coder (CEMC), and/or Certified Risk Adjustment Coder (CRC) preferred.

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