Manager of Professional Coding and CDI - Memorial Health Care Center

JOB SUMMARY

Works under the general supervision of the Director of Health Information Management (HIM), the Manager of Professional Coding and CDI oversees the activities of the MMA Coding and Clinical Documentation Integrity program.  Responsible for daily operations, management, financial data reports, the implementation of procedures for coding, and further growth in the area with the medical practices.  Ensures optimum reimbursement for Physician Services through accurate and timely coding of all professional services. As a customer-focused team member, he/she must be accessible, flexible, knowledgeable and responsive. Strives for superior performance by consistently providing a product or service to leadership and staff that is recognized as ultimately contributing to the patient and family experience. Recognizes and demonstrates understanding of patient and family centered care.

PRIMARY JOB RESPONSIBILITIES

1. Demonstrates knowledge of, and supports, Memorial Healthcare’s mission, vision, value statements, Standards of Behavior, policies and procedures, operating instructions, HIPAA Privacy and confidentiality standards, corporate compliance plan, code of ethical behavior and commitment to service excellence. 
2. Oversee the day-to-day operations of the Professional Coding and CDI Department to ensure compliance with all third party and government regulations.
3. Manage the daily coding and CDI workload and adjusts coders and CDI specialists work schedules to meet the demands of the department.
4. Designs and implements coding and CDI policies and procedures to ensure departmental and facility operations comply with state and federal regulations.
5. Develops and launches coding improvement initiatives based on areas of opportunity identified through audits and other assessments; monitors and contributes to the success of improvement plans.
6. Monitor open and missing encounters while working with MMA managers and MMA directors of practice management.
7. Monitor daily imports and assign them to coders to process in a timely manner.
8. Responsible for department's operational excellence; assures department delivers quality services in accordance with applicable policies, procedures and professional standards.
9. Conducts/coordinates regular coding quality reviews and coordinates ongoing monitoring of coding accuracy and clinical documentation adequacy.
10. Ensure coding staff maintains a high quality and productivity standard, per Memorial Healthcare benchmark and take appropriate action.
11. Performs educational sessions for coding team, documentation specialists, and physicians.
12. Develops and maintains coding guidelines for the coding staff and coordinates the ongoing development of the coding staff as indicated.
13. Remains current in coding and/or documentation requirements. Suggests coding process improvements for optimal coding reimbursement.
14. Monitor changes in laws, regulations, and policies that impact clinical documentation, reimbursement and coding to assure compliance.
15. Monitors unbilled account reports for outstanding services or un-coded encounters to reduce accounts receivable days for office visits.
16. Management-level responsibilities include: Time & attendance, hiring, performance appraisals, disciplinary actions, training, work distribution and flow, and employee engagement.
17. Assists in the preparation and review of the departmental budget.
18. Protects the confidentiality of patient information per HIPAA regulations.
19. Performs other duties as directed.

JOB SPECIFICATIONS

EDUCATION

1. Associate degree in Health Information Technology is required.  Bachelor degree in Health Information or related field is strongly preferred. 
2. Certified Professional Coder (CPC) or Registered Health information Technician (RHIT) or Certified Coding Specialist (CCS) is required.
3. Certified Medical Assistant preferred.

EXPERIENCE

1. Five years of professional experience required in management and physician billing and coding.
2. Complete knowledge of ICD-10 and CPT-4 coding procedures.
3. Current knowledge of, or willingness and ability to learn, guidelines for Medicare, BCBS, Medicaid and Managed Care along with other commercial insurances, Workmen's Compensation Policies and procedures.
4. Knowledge of current billing issues and legislation.
5. Knowledge of computerized medical and management software systems.
6. Knowledge of PC Spreadsheet Software.
7. Knowledge of basic accounting principles.

ESSENTIAL PHYSICAL ABILITIES/MOTOR SKILLS

1. Able to travel independently throughout all Memorial Healthcare facilities (including crowded or confined areas).
2. Small motor skills required for operating modern computer, office, and telephone equipment as utilized by Memorial Healthcare (MHC).
3. Must be able to sit or stand for long periods of time.
4. At minimum, 75% of time spent on the job will require standing or ambulating.

ESSENTIAL MENTAL ABILITIES

1. Ability to adapt and maintain focus in fast paced, quickly changing or stressful situations.
2. Ability to read and interpret a variety of documents including, but not limited to policies, operating instructions, white papers, regulations, rules and laws.
3. Ability to work in a stressful environment due to time constraints and handle difficult and sensitive situations tactfully.  
4. Ability to follow instructions to learn work routines and problem solving.  
5. Must be self-motivated with the ability to work independently.

ESSENTIAL TECHNICAL/MOTOR SKILLS

1. Proficiency using modern office, computer and telephone equipment as used by Memorial Healthcare.
2. Motor skills required to page through hard copy and computerized records.

ESSENTIAL SENSORY REQUIREMENTS

1. Able to see for the purpose of reading information received in formats including but not limited to paper, computer, reports, bulletins, updates, manuals.
2. Able to hear for work-related purposes.
3. Ability to communicate through written and verbal communications receptively, expressively, and with professionalism.