Job Description

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.

KEY RESPONSIBILITIES:

  • 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/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:

  1. Education: Bachelor’s degree required
  2. Experience 10 years progressive HIM Coding Management experience within an Acute Care Hospital setting. Extensive experience with Revenue Cycle operations including acute care coding.
  3. Certification/Licensure: RHIA or RHIT with CCS
  4. Software/Hardware: Meditech and 3M 360 experience required
  5. Other: Required to work out of Steward Health Care office located in Richardson, Texas.
  6. Travel: Expected travel is up to 10%. Education and/or company growth.

Application Instructions

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