Mgr Hospital Coding Audit Edu & Quality Assurance

Summary: Responsible for the professional development of the coding staff and for providing a hospital-wide educational program to assist coders in continued coding and documentation education. Performs quality assurance reviews of inpatient and outpatient records to assess and report on the effectiveness of training programs and quality of coders. Provides in-service training and feedback to coding staff regularly including coding changes and updates. Designs and implements programs on coding and clinical documentation audit and education to improve performance and efficiency. Partners with CDI management to develop appropriate guidelines regarding IP and OP coding. Enforces correct application of Official Coding Rules and Regulations and follows appropriate guidelines including Coding Clinic. The Manger Coding Validation and Quality Assurance may help represent the Clinical Documentation Coding Integrity (CDCI) Department at clinical meetings when requested to serve as a resource for coding guidelines and interpretation. Manager will play a critical role in driving accuracy and continuous improvement of the hospital coding process while fostering a positive and supportive work environment. Manager will oversee quality reviews for Artificial Intelligence used by coding department. Responsibilities: KEY ACCOUNTABILITIES: Consistently applies the corporate values of respect honesty and fairness and the constant pursuit of excellence in improving the health status of the people of the region through the provision of customer-friendly geographically accessible and high-value services within the environment of a comprehensive integrated academic health system. Responsible for knowing and acting in accordance with the principles of the Brown University Health Corporate Compliance Program and Code of Conduct. ESSENTIAL FUNCTIONS: Training and On-Boarding: Work with the Director of Coding to make sure that all training programs are developed to include personal learning styles. Work to assure the training and onboarding process does not have bottlenecks. The goal is to get someone onboarded into production within a week. Assure that all individual coders have a 95% or better or the proper action plans training and remediation happen. Track the numbers and costs of quality issues turnover and rework. Develop best practices workflows and reporting to assure high quality results. Develop a quality program that meets our contractual obligations as well as assures our coders are performing at an optimal level to meet customer expectations. Work within the guidelines to meet budget obligations and reduce the amount of over-read and re-work. Collaborate with HR to recruit hire and onboard coding professionals with the required skill set and expertise. Monitor coding staff workload and redistribute resources as needed to meet operational demands. Productivity and Quality Management: Establish key performance indicators (KPIs) for coding productivity and accuracy. 95% quality 5% rework Monitor coding processes to identify bottlenecks inefficiencies and areas for improvement. Implement process enhancements to streamline workflows and increase productivity while maintaining high-quality standards. Coding Education: Oversee a comprehensive training program for coding staff to ensure continuous skill development and compliance with industry standards. Stay updated with evolving coding guidelines regulations and technologies and integrate these updates into training materials. Conduct regular training sessions and workshops to improve coding proficiency and keep staff up to date. Identify error trending and develop course work to focus on specific problem areas. KNOWLEDGE AND SKILLS: Must possess extensive knowledge of hospital inpatient and outpatient reimbursement methodologies. Excellent skill in providing hands-on education to CDCI staff based on audit finding and need. Strong knowledge of health records computerized billing and charging systems Microsoft applications data integrity and processing techniques required. Identify and report on key performance indicators for coding audit and compliance. Work requires in-depth knowledge of medical terminology ICD-10-CM/PCS and CPT-4 Coding conventions and knowledge of the various DRG systems (CMS DRGs AP-DRG and APR-DRGs). Work also requires basic concepts of human anatomy physiology and pathology. Strong knowledge of health records computer systems Microsoft applications data integrity and processing techniques required. Ability to mentor guide and motivate direct reports through demonstration of best practices and leading by example. Excellent organizational skills including ability to multi-task prioritize essential tasks follow-through and meet timelines. Ability to solve problems appropriately using job knowledge and current policies/procedures. Present audit findings to the stakeholders in a way that allows the stakeholder to understand and implement the findings for improvement. Ability to maintain and enforce strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations. Excellent organizational skills including ability to multi-task prioritize essential tasks follow-through and meet timelines. Stay updated with evolving coding guidelines regulations and technologies and integrate these updates into training materials. Conduct regular training sessions and workshops to improve coding proficiency and keep staff up to date. Identify error trending and develop course work to focus on specific problem areas Must be able to maintain strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations. Ensure adherence to the AHIMA Standards of Ethical Coding and the AHIMA Code of Ethics. PERFORMANCE STANDARDS: Effective utilization of resources Management of continuous quality improvement High quality high value patient-focused services Resource productivity Fiscal responsibility Development and implementation of effective quality programs Customer satisfaction Performance improvements year-to-year Positive feedback from peers direct reports and staff Other information: QUALIFICATIONS/EXPERIENCE:  Command of the ICD-9/10-CM and CPT4/HCPCS coding conventions E&M coding diagnosis-related groupings (DRG) and ambulatory patient groupings (APG) methodology. Work also requires concepts of human anatomy physiology and pathology. Excellent skill in providing hands-on education to Coding & CDI staff based on audit finding and need. Strong knowledge of health records computerized billing and charging systems Microsoft applications data integrity and processing techniques required. Excellent organizational skills including ability to multi-task prioritize essential tasks follow-through and meet timelines. Ability to work with accuracy and attention to detail. Ability to solve problems appropriately using job knowledge and current policies/procedures. Ability to work cooperatively with members of the healthcare delivery team and staff ability to handle frequent interruptions and adapt to changes in workload and work schedule and to respond quickly to urgent requests. Must have Clinical knowledge to interpret Medical Records primary diagnosis Must be able to maintain strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations. Must possess extensive knowledge of hospital inpatient and outpatient reimbursement methodologies. Work requires in-depth knowledge of medical terminology ICD-10-CM/PCS and CPT-4 Coding conventions and knowledge of the various DRG systems (CMS DRGs AP-DRG and APR-DRGs). Work also requires basic concepts of human anatomy physiology and pathology. Strong knowledge of health records computer systems Microsoft applications data integrity and processing techniques required. Ability to mentor guide and motivate direct reports through demonstration of best practices and leading by example. Excellent organizational skills including ability to multi-task prioritize essential tasks follow-through and meet timelines. Ability to solve problems appropriately using job knowledge and current policies/procedures. Ability to maintain and enforce strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations. Must possess extensive knowledge of payer claim edits and payer denials. Work requires in-depth Education: Bachelors degree or equivalent combination of formal education and experience. CERTIFICATES LICENSES REGISTRATIONS REQUIRED : CCS and AHIMA Certified ICD-10 Trainer credentials required. Additional RHIA RHI or other coding credential is preferred. Must have at least five years of experience in coding; experience must include education/mentoring/training. Minimum of five years acute care hospital experience coding with ICD-9/10-CM/PCS and CPT-4 academic medical setting or trauma center preferred. Minimum of three years management experience required; five years preferred. SUPERVISION:  Up to 25 FTE's Brown University Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status.   Brown University Health is a VEVRAA Federal Contractor. Location: Corporate Headquarters USA:RI:Providence Work Type: Full Time Shift: Shift 1 Union: Non-Union

Created: 2024-10-19