Supervisor of Coding Operations, Audit, and Integrity
Company: Waterbury Hospital
Posted on: November 19, 2023
JOB TITLE: Supervisor of Coding Operations and HIM Analyst
DEPARTMENT/ GRADE / CODE: HIM/MGT/L5
REPORTS TO: Director of HIM
SCOPE OF POSITION:
Under the direct supervision of the Director of Health Information
Management, the supervisor of coding operations and business
applications is responsible for providing leadership and direction
to all aspects of the coding unit and oversight and monitoring of
the HIM Department business applications. The supervisor oversees
staffing to ensure that productivity and quality expectations are
consistently monitored, measured, and achieved and backlogs are
avoided while promoting and supporting a culture of continuous
learning throughout the coding unit.
The supervisor plans, coordinates and executes daily coding
workflow, performs monthly coding audit activities, and manages
system upgrades, testing and optimization. This person functions as
a working supervisor who can work coding, billing, denial and claim
edits and provide additional coding intervention during peak volume
times. The supervisor will participate in ongoing revenue cycle
projects and initiatives as assigned.
The supervisor is responsible for the hiring, training,
cross-training and performance of the hospital-based coding staff
who review, interpret, abstract and perform coding duties for
inpatient, observation, ambulatory surgery, ancillary and recurring
Under the supervision of the HIM department director, supervises
the coding team and the day to day operations of the coding
Monitors DNFB daily and allocates resources appropriately to keep
coding turnaround within goal.
Performs ongoing quality audits of inpatient and outpatient records
to validate the assignment of ICD-10, CPT, HCPCS Level II, POA
indicators, HACs, and modifier codes to ensure accurate MS-DRG,
DRG, and APC assignments.
Communicates timely feedback of audit findings and corrective
actions/measures to the HIM Director.
Prepares summary reports and action plans for identified areas for
coding improvement to management.
Identifies educational needs of coders and provides education and
training to coding staff on an ongoing basis
Meets with coding staff regularly to review workflow, provide
departmental updates, and present audit findings and corrective
action plans. Follows up on action plans to ensure ongoing quality
of coded data.
Ensures coder adherence to established quality and productivity
standards. Works with the HIM Director to initiate performance
improvement plans and disciplinary action when warranted.
Prepares monthly quality and productivity coding reports.
Makes recommendations to HIM management for process/performance
Serves as a subject matter expert for ICD10 and ICD10 PCS inpatient
coding and CPT outpatient coding guidelines and related topics.
Leads and participates in revenue cycle and other coding related
meetings to provide subject matter expertise and share best
Monitors case mix and identifies practice patterns, trends, root
causes for variations in coding. Makes recommendations to HIM
management for process/performance improvement.
Demonstrates knowledge and proficiency with HIM software
applications, groupers, and operational systems relative to
Ensures that systems and applications are set up for maximum
efficiency and optimized for streamlined use within the HIM
Facilitates HIM system updates in conjunction with IT including
testing scenarios and post-implementation review.
Creates, maintains, and updates hospital-wide forms library as
forms are implemented and/or revised.
Maintains the legal record grid and assists in organizing new and
revised documentation in the EHR to ensure efficient organization
Performs technical support for all HIM Revenue Cycle
Trains and provides support to HIM staff on all HIM related
Designs training materials and procedures to ensure effective usage
of all computer systems.
Develops and delivers ongoing physician education in conjunction
with input from medical staff leadership and Clinical Documentation
Improvement (CDI) leadership. Develops necessary resources and
education materials accordingly.
Maintains and shares current knowledge of developments and trends
in prospective payment, coding guidelines and related health care
Assists in the dissemination of coding information to coding
personnel including proposed changes in regulations and the
anticipated impact on the organization.
Participates in updating/revising policies and procedures as
appropriate and ensures they reflect recognized current coding
Represents the HIM department on various committees and work
Abides by the Standards of Ethical Coding as set forth by the
American Health Information Association. Monitors coding staff for
adherence to ethical conduct and reports concerns.
Works closely with CDI, Patient Financial Services, Case Management
and Patient Access staff to ensure accurate and timely coding.
Maintains professional development through attendance at in-service
education programs and outside conferences.
Assists in the selection, training, and orientation of coding
Provides cross-training to the coding staff to enhance and promote
Oversees and validates the accuracy of outsourced coders'
performance and productivity.
Demonstrates competence in preventing, managing, and resolving
billing edits and coding related denials.
Responds to internal/external questions regarding the accuracy of
Performs root cause analysis of coding denials to identify trends
and implement process improvements.
Reviews edits for medical necessity to ensure compliance with Local
Medical Review Policies and National Coverage Determinations
Provides feedback of patterns, trends, and reasons for denials to
coders, physicians, and other department staff to improve
documentation and coding and to reduce the number of edits and
Maintains current knowledge of developments and trends in Medicare
policies, coding guidelines and related health care delivery
Foster and maintain professional and effective relationships with
Other duties as assigned.
Graduate from an approved Health Information Management Program
with credentials of Registered Health Information Administrator
(RHIA) or Registered Health Information Technician (RHIT)
Coding credential required.
Minimum of two to three years of inpatient and outpatient
supervisory/lead experience required.
Minimum of three years ICD10 and ICD10 PCS coding required.
Minimum of three years CPT coding required.
3M Encoder experience is required.
Experience with Cerner EMR preferred.
Experience with 3M 360 preferred.
Strong supervisory skills and ability to manage people.
Strong analytical, problem solving, and organizational skills.
Ability to prioritize workloads; meet deadlines and work
effectively under pressure.
Attention to detail.
Sufficient in Microsoft excel.
THE ABOVE DESCRIPTION COVERS THE MOST SIGNIFICANT DUTIES PERFORMED
BUT DOES NOT EXCLUDE OTHER OCCASIONAL WORK ASSIGNMENTS NOT
MENTIONED, THE INCLUSION OF WHICH WOULD BE IN CONFORMITY WITH THE
FACTOR DEGREES ASSIGNED TO THIS JOB.
REVISED DATE: 03/2021
Location: Waterbury Hospital - Health Information Management
Schedule: Full Time, Days, 40 HR Days 8:00am-4:30pm
Keywords: Waterbury Hospital, Waterbury , Supervisor of Coding Operations, Audit, and Integrity, Accounting, Auditing , Waterbury, Connecticut
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