Job Summary:

Under direction, supervises the work of staff who review, interpret, code and abstract medical records information according to standard classification systems; performs the most advanced medical records coding and abstraction duties; performs data quality reviews and prepares complex reports as required; and performs other related duties as assigned.

Responsibilities:

Supervises and performs a wide range of activities pertaining to the review and coding of inpatient medical record information.
Establishes, implements and maintains a formalized review process for coding compliance, including a formal review (1st level 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.
Creates and monitors inpatient case mix reports and the top DRG's to identify patterns, trends and variations in the facility's frequently assigned DRG groups; investigates and evaluates potential causes for changes or problems; takes appropriate steps in collaboration with the right staff to effect resolution or explain variances.
Continuously evaluates the quality of clinical documentation to identify incomplete or inconsistent document for inpatient encounters that impact the code selection and resulting DRG groups and payment; brings concerns to the attention of the Supervisor/Client for resolution.
Provides or arranges for training of healthcare professionals in the use of technical coding guidelines and practices, proper documentation techniques, medical terminology and disease as they relate to the DRG, 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.
Selects, assigns, and collaborates with the training department to educate subordinate technical and clerical staff; 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.
Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association; reports areas of concern to the Director.
Assists the Director by serving as a representative for Inpatient Coding by attending coding and reimbursement workshops and bringing back information as appropriate; communicates any updates published in third-party payer newsletters, bulletins and/or provider manuals; shares information with 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 division.
Monitors unbilled account reports for outstanding services or un-coded discharges to reduce accounts receivable days for inpatients (if applicable); performs periodic claim form reviews to check code transfer accuracy from the abstracting software and the charge master (if applicable).
In partnership with appropriate personnel, recommends and implements standardized, organization-wide coding guidelines and documentation requirements; in conjunction with the training team develops and implements training and educational programs for coders.
Consults with other divisions and individuals regarding data quality management.
Performs other related duties as assigned.

Qualifications:

Minimum of 3-5 years of Inpatient coding including prior supervisory or management responsibility
Must have the following certifications: CCS/CIC/CPC
Advanced principles and practices of medical record keeping; advanced medical terminology, anatomy, and physiology, as well as the states, sequence, progression and description of diseases as they apply to medical record coding and abstraction
Advanced elements of ICD-10-CM, and ICD-10-PCS coding systems.
Ability to read, interpret and evaluate complex technical reports and information

Operations Manager - Inpatient Medical Coding | Work from Home