Manager, HIM Outpatient Coding
The Health Information Management Outpatient Coding Manager shall be responsible for Outpatient coding functions within the Central Division. The Outpatient Coding Manager shall ensure a 96% or better APC/CPT/HCPCS accuracy and that all patient type productivity standards are met consistently.
- Direct management responsibility over all Central Division Outpatient coding. This includes Observation, Outpatient in a Bed, Outpatient Surgical, Routine Outpatient, Emergency department, and series accounts.
- Extensive knowledge of APC classification and reimbursement structures.
- Extensive knowledge in ICD-10-CM, CPT, and HCPCS coding.
- Extensive knowledge of National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs).
- Responsible for 96% Outpatient reimbursement accuracy. Includes proper assignment of APC, CPT, HCPCS, and modifier assignment.
- Ensure Payer Billing Guidelines are followed and education provided to outpatient coding staff.
- Responsible for scheduling coder work shifts and approving time off.
- Responsible to ensure coders are meeting productivity standards. Includes presenting a monthly report to the Executive Director, Health Information Management.
- Closely monitors DNFB accounts
- Ensure that claim hold reason is assigned before account hits DNFB report.
- Ensure that second level coding review and charge audit is completed on complex Interventional Radiology and Cardiac Cath lab accounts.
- Maintain open communication with hospital leadership team including daily escalation of missing reports from providers.
- Trend and track coding queries issued by discharged coders.
- Ensure coding staff holds accounts until all medical content is collected before final billing. This includes H&P’s, Operative Reports, Pathology Reports, etc.
- Promote a culture of collaboration between hospital leadership and shared service professionals.
- Coordinate workflow improvements with HIM Operations Management.
- Ability to develop, adhere to, and monitor policies and procedures for optimal revenue through coding that comply to all regulatory and compliance standards.
- Abides by the Standards of Ethical coding set forth by AHIMA and monitors coding team.
- Present monthly status and goal report to Executive Director, Health Information Management.
- Maintain Discharged, but Not Final Billed goals set by Executive Director, Health Information Management.
- Ensure SHC policies related to HIM, Revenue Cycle, and Compliance are implemented and monitored.
- Implement HIM related projects at the direction of the Executive Director, Health Information Management.
- Support hospital based departments; e.g., Quality, Risk Management, and Case Management with respect to HIM coding.
- Work with other SHC senior leaders as needed.
- Assists HIM Leadership team with development and implementation of health information management coding/CDI policies.
- Monitors changes in legislation and accreditation standards that affect health information management.
- Ensure that all coders have been awarded a professional AAPC or AHIMA coding credential. Prefer CCS.
- Knowledge of UB Editor and Revenue Codes
- Responsive to senior management during off hours and/or weekends.
REQUIRED KNOWLEDGE & SKILLS:
- Meditech experience required
- Extensive experience with OPPS, UHDDS, Coding Clinic
- Microsoft Office (Word, One Note, Excel, Outlook, PowerPoint)
- Excellent verbal and written communication skills
- Ability to meet assigned deadlines.
- Extensive knowledge of Anatomy & Physiology, Medical Terminology, and Pathophysiology
- Education: Bachelor’s degree required
- Experience 10 years progressive HIM Coding Management experience within an Acute Care Hospital setting. Extensive experience with Revenue Cycle operations including acute care coding.
- Certification/Licensure: RHIA or RHIT with CCS
- Software/Hardware: Meditech and 3M 360 experience required
- Other: Required to work out of Steward Health Care office located in Richardson, Texas.
- Travel: Expected travel is up to 10%. Education and/or company growth.