Regional Coding Review Manager

Manages and plans high quality and accuracy Health Information Management Department related reviews such as, concurrent and retrospective pre-bill coding audits. Performs analysis, and develops training and education related to all facets of the health information management department career ladder. Analyzes audit results, focusing on the correct code assignment of: AMA CPT, ICD-9-CM/ICD-10 CM/PCS, MS-DRG, HCC, and HCPCS codes. As needed, performs analysis of audit results for Medicare Risk adjustment, and clinician documentation to achieve compliance with all regulatory guidelines and internal controls. Audit span will encompass: internal practitioners, contracted practitioners, coders, internal facilities as well as contracted facilities. This position will serve as a liaison between the Regional Revenue Cycle Executive Directors, HIM staff, Clinicians, and other regional departments as appropriate. The training and education responsibilities of this position will include designing and developing training modules, instructing current coders and coder trainees about coding guidelines, code changes and observed issues from the audits. Extensive knowledge of ICD-9-CM/ICD-10-CM & PCS/MS-DRG/HCC and AMA CPT coding is required to perform the above functions. Additionally, applicant qualifications should include excellent analytical and communication skills. Applicants must be able to travel if necessary.

• Assists Regional Coding Teams and Health Information Management Managing Director in meeting coding quality and productivity goals and objectives by - identifying opportunities for continuous quality improvement.
• Communicates and participates in operational and strategic regional planning.
• Actively involved in designing and developing training modules as a means of mentoring and training in all functions and services related to hospital medical coding, medical documentation, physician queries, electronic health record abstracting and data collection.
• Monitors coding and abstracting quality by conducting and/or coordinating ongoing audits in order to ensure that coding quality and performance improvement standards are achieved, maintained and or improved.
• Works closely with the Coding Supervisors, HIM Directors as well as the members of labor unions to: develop, implement, evaluate and improve coder participation in the HIM Department Coder Training and Transition Programs.
• Provides ongoing coding and systems education and training of staff through:
• Monthly or bi-monthly CPT and ICD classification system training.
• Health Connect end user training.
• Answering coding questions posed by regional coders.
• Provides Clinical Documentation Improvement training to staff through:
• Coordination of physician concurrent record review.
• Provides all facets of Career Ladder Training to represented staff.
• Focus training for employees undergoing Reduction in Staff (RIF).
• Provides Shared Services training as needed, such as:
• CPT and ICD classification system training for Regions Outside California (ROC).
• Development of training materials for Regions Outside California (ROC).
• Tracks and reports on the progress of trainees at each phase of program training.
• Assists Regional Coding Team in preparing and analyzing statistical data in an effort to improve clinical patient outcomes.
• Ensures compliance with all applicable federal, state and local regulations, as well as with institutional/organizational standards, practices, policies and procedures.
• Strong research skills including knowledge of automated analysis tools and on-line research tools required to resolve complex coding/systems issues.
• Must be able to work flexible days and hours.
• Travel between Medical Center facilities/Regional Offices will be required periodically.
• Other duties as assigned.

Qualifications:

• Minimum four (4) years relevant experience assigning ICD-9-CM diagnoses and procedure codes, AMA CPT, and CMS HCPCS codes.
• Minimum four (4) years combined experience assigning and auditing AMA CPT and CMS HCPCS codes, as well as ICD-10-CM/PCS and ICD-9-CM diagnoses and procedure codes in an acute care setting required.

• High School Diploma or General Education Development (GED) required.

• Registered Health Information Technician OR Certified Coding Specialist OR Certified Professional Coder OR Registered Health Information Administrator

• Extensive inpatient coding experience in an acute care facility required.
• Must possess a proficient understanding of the Inpatient and Outpatient Prospective Payment Systems (IPPS/OPPS), Medical Severity Diagnosis-Related Groups (MS-DRG), National Correct Coding Initiative Edits (NCCI), ICD-9-CM Official Guidelines for Coding and Reporting, and Coding Clinic.
• Must be able to develop and present training curricula for coders and healthcare providers based on analysis of audit data.
• Knowledge of laws and regulations pertaining to Health Information Management (e.g., TJC, HIPAA, CMS, OSHPD, DHS, Uniform Health Care Information Act) required.
• Ability to demonstrate knowledge of and utilize health information management professional practice standards, principles, techniques and methodologies.
• Ability to demonstrate knowledge of and utilize, apply, interpret and train on current coding classifications systems and documentation guidelines.
• Must be able to work in a Labor-Management Partnership environment.

• N/A.