Manager - Inpatient Clinical Coding

About the role

This position manages HIMs Clinical Data Section, which is accountable for: coding and abstracting the medical records of inpatients; preparing statistical analysis of medical records data; compiling, analyzing and summarizing data from medical records into various formats. The output of this Section is used for: meeting hospital licensure requirements; financial and billing purposes, which includes the identification and determination of appropriate reimbursement under inpatient prospective payment systems; maintenance of acceptable accounts/receivables and DNB levels; compliance with internal and external regulatory agencies, such as Quality Improvement Organizations, the Centers for Medicare & Medicaid Services, and Joint Commission.

Responsibilities

• Coordinates hospital DRG activities through chart reviews, DRG validation activities, and provides information and reports to fulfill requests made by members of the medical staff, administration and planning.
• Works well with Physician CDI leadership to appropriately identify documentation improvement standards.
• Demonstrated abilities to: correctly interpret and apply Federal regulations and PRO requirements in the assignment of DRG's and in the interpretation of various billing guidelines (i.e., medical necessity, resident supervision policies, correct coding initiative, etc.)
• Ability to direct concurrent and retrospective coding reviews and provide physician education for ICD 10 CM and PCS.
• Effective skills in leadership, communications, coaching, planning, motivation, and establishing effective working relationships with at all levels of staffing in the organization.

Requirements

A minimum of four years' prior successful supervisory experience. Advanced education which should include communication and mathematical/statistical skills and/or extensive knowledge in organization, research and analysis normally acquired through the completion of Health Record Administration/Science Bachelor's program with certification as an RHIA and coding credentials (CCS, CPC).

Qualifications

• Full working knowledge of: medical information and revenue cycle systems; Grouper and Severity of Illness Systems; medical record systems, medical terminology, anatomy, physiology, pathophysiology, microbiology, and pharmacology; State, Federal and Joint Commission requirements pertaining to medical records;
• Has a good understanding of Clinical Documentation Improvement Programs to effectively collaborate with the Coders and CDI Nurse team, assisting with facilitating the CDI Task Force Meetings as well as CDI Leadership Meetings.

Skills

• Skilled in ICD coding and case mix index management.
• Experienced with EPIC, HP CDM, claim edit processes, 3M encoder and CDI programs.
• Prior CAC and Lawson a plus.

Benefits

With a career at any of the MaineHealth locations across Maine and New Hampshire, you’ll be working with health care professionals that truly value the people around them – both within the walls of the organization and the communities that surround it. We offer benefits that support an individual's needs for today and flexibility to plan for tomorrow – programs such as paid parental leave, a flexible work policy, student loan assistance, training and education, along with well-being resources for you and your family.

Pay

Commensurate with experience.

Schedule

N/A