Supervisor of Coding Operations, Audit, and Integrity

Company: Waterbury Hospital
Location: Waterbury
Posted on: November 19, 2023

Job Description:

JOB TITLE: Supervisor of Coding Operations and HIM Analyst
DEPARTMENT/ GRADE / CODE: HIM/MGT/L5
REPORTS TO: Director of HIM
SUPERVISES: NA
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 record types.
RESPONSIBILITIES:
Under the supervision of the HIM department director, supervises the coding team and the day to day operations of the coding unit.
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 improvement.
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 practices.
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 HIM.
Ensures that systems and applications are set up for maximum efficiency and optimized for streamlined use within the HIM department.
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 and navigation.
Performs technical support for all HIM Revenue Cycle applications
Trains and provides support to HIM staff on all HIM related computer applications.
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 delivery issues.
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 guidelines.
Represents the HIM department on various committees and work groups.
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 staff.
Provides cross-training to the coding staff to enhance and promote staff development.
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 code assignments.
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 (NCD).
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 denials.
Maintains current knowledge of developments and trends in Medicare policies, coding guidelines and related health care delivery issues.
Foster and maintain professional and effective relationships with department leadership.
Other duties as assigned.
REQUIREMENTS:
Graduate from an approved Health Information Management Program with credentials of Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) preferred.
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