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Responsibilities*

BASIC FUNCTION AND RESPONSIBILITY

The Manager of Coding Quality and Education is responsible for developing, implementing, and maintaining a quality management program to support improvement in coding completeness and accuracy.  The manager reviews coding performance, provides performance metrics to appropriate managers, and ensures successful staff education.  Additionally, the manager oversees payer denials and the appeals process relevant to inpatient facility coding.

This individual develops and maintains policies and procedures that will improve and support revenue cycle operations and organizational goals, as well as promote timely and accurate coding practices that comply with organizational policies, OIG guidelines, and other applicable regulations.  Overall, the manager utilizes project management skills, clinical knowledge and understanding of documentation and coding requirements to improve processes and compliance.

The Manager will oversee the Inpatient and Outpatient Facility/Professional (OP Facility/Professional) Medical Coder Compliance Specialists (MCCS). These professionals support coding compliance, training, and continuing education. The Manager also oversees the IP Facility Appeals Coordinator who supports the 3rd party payer DRG and Clinical Validation appeals process.

 

SPECIFIC DUTIES AND RESPONSIBILITIES

LEADERSHIP

  • Analyze effectiveness of OP Facility/Professional coding operations to identify opportunities for process improvement using Lean and High Reliability methodologies to streamline processes and ensure the most efficient use of Revenue Cycle Coding resources to meet the needs of the organization as a whole.
  • Monitor changes in laws, regulations and policies that impact coding and reimbursement and assure compliance with coding procedures and work flows.
  • Assist the Revenue Cycle Coding Directors and Coding Managers in the development, implementation and assessment of long range and short-term goals for the Coding Unit.
  • Provide leadership representation on institutional committees as it relates to assigned units.
  • Provide leadership for and actively participate in departmental and institutional activities and programs.
  • Identify and address change management issues related to the evolution of the Revenue Cycle environment.

 

Program

  • Establishes, implements, and maintains a formalized review process for coding compliance, including a formal review (audit) process. Designs and uses audit tools to capture, monitor, and report the accuracy of ICD-10-CM, ICD-10-PCS, and CPT coding, modifier application, and other coded data elements.
  • Manages the IP Facility payer denials and appeals process within scope; including the process of tracking and analyzing external audits conducted by third party payers and government agencies.
  • Manages communication and follow-up processes related to IP Facility clinical and coding denials and ensures such activities are submitted, tracked, trended and reported timely to key stakeholders.
  • In partnership with the IP/OP/Professional Coding leadership teams, ensures compliance with the organization’s coding procedures and standards as well as third-party coding regulations such as, but not limited to, CMS, the Official Coding Guidelines for ICD-10, CPT, ASA, NCCI, LCD/NCD, and external regulatory and accreditation requirements.
  • Establishes, maintains, and communicates standards and guidelines related to: internal quality reviews, compliance initiatives, reporting initiatives, benchmarking, research and analysis, continuous improvement opportunities, strategic planning, or other requested projects in partnership with unit and departmental leadership.
  • Assists coding leadership by making recommendations for process improvements to further enhance coding quality goals and outcomes.
  • Creates, reviews and updates the Revenue Cycle Coding Compliance Plan and program in response to changing organizational needs or new or revised regulations, policies, or guidelines and incorporate changes into audit practice.
  • Leads the Coding Compliance and IP Facility Appeals/Denials staff. Conduct regular staff meetings for a home-based workforce.

 

Training/Education

  • Develops in-service training programs related to coding for coding and CDI staff.
  • Develops and implements coding training plans within Revenue Cycle, including curriculum development, preparation and delivery of training to improve the accuracy, integrity and quality of patient coded data and to improve the quality of provider documentation within the body of the medical record to support code assignment.
  • In coordination with others, provides education to clinical departments and impacted clinical leaders as requested on areas of coding.
  • Researches, summarizes and disseminates information regarding new coding requirements (e.g. CMS code updates) and updates appropriate stakeholders, coding and CDI staff.

 

Data Analysis/Reporting

  • Actively engages in analysis of data, plans for improvement and re-measurement activities to assess performance improvement as dictated by quality program targets.  Recommends corrective action and improvements to internal processes.
  • Analyzes audit findings to identify trends and patterns, makes recommendations for additional focused audits, follows up actions and/or coder education and training as well as analyses of potential and actual financial risks.
  • Monitors and evaluates the effectiveness of education and training programs and develops correction action plans based on key performance measures.
  • Reviews IP Facility third-party audit results to understand reasons for denials, performs root cause analysis, and provides feedback to staff and stakeholders.
  • Prepares comprehensive reports as requested by state or federal agencies or other regulatory agencies, and as directed by leadership.
  • Evaluates and monitors the impact of coded data on facility and professional reimbursement, benchmarking, performance and outcome measure initiatives including, but not limited to:

Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators

Center for Medicare/Medicaid Services (CMS) Hospital Acquired Conditions, Pay for Performance, and Core Measures

US News and World Report

Leapfrog survey data

Michigan Surgical Quality Collaborative (MSQC)

Vizient

Michigan Health and Hospital Association (MHA)

 

PARTNERSHIPS

  • Provide feedback to leadership on reimbursement opportunities and compliance issues found as a result of audits.
  • Serves as a resource for Corporate Compliance, Revenue Cycle, clinical departments and administration to obtain information and clarification on coding standards, guidelines and regulatory requirements.
  • Serves as liaison and subject matter expert for organizational departments requiring assistance with coding and documentation.

 

Coding

  • Partners with coding leadership in developing a strategy and programs to address high-risk coding practices, making recommendations for corrective action plans or process improvements and creates policies, procedures, and internal controls which reinforce the highest level of standard of coding quality goals and outcomes.
  • Partners with Revenue Cycle coding leadership to develop coder training programs (e.g. new coder, continued training)

 

Clinical Documentation Integrity

  • Ensures the collaboration required between the Clinical Documentation Improvement and Coding functions are optimal to achieve the excellence required.
  • Identifies patterns, trends and variations in provider documentation practices. Provides feedback and updates on quality improvements, trends, issue resolution and implementing changes. Takes appropriate steps in collaboration with the right staff or department to effect resolution or explanation of the variances.

 

Other

  • Reviews external resources and relevant publications on a continuous basis to maintain currency of coding changes that may affect the organization.
  • Provides input and/or oversight to the selection and operational use of electronic auditing, coding and clinical documentation improvement software solutions, aides in the development of work queues used for coding audits or payer denials, and platforms necessary to support data collection of auditing activity.
  • Serves on hospital committees and work groups as assigned.
  • Refine internal workflows, tools and training to support high productivity, quality and efficiency
  • Utilizes Lean and High Reliability principles to develop standard work and continuous process improvement within the department.

 

COMPETENCIES

  • Ability to work independently as well as with a diverse group of people in a diplomatic and effective manner.
  • Strong customer focus and the knowledge and skill to identify, meet and evaluate customer expectations.
  • Strong presentation skills and a track record of ability to present to senior leadership.
  • Exceptional ability to lead, manage, and mentor staff through complex work redesign efforts.
  • Logical, analytical, and organized with the ability to reprioritize quickly and efficiently.
  • Complies with all aspects of coding, abides by all ethical standards, and adheres to official coding guidelines.
  • Ability to work in a fast-paced environment under multiple pressures and deadlines.
  • Excellent verbal and written communication skills up, down, and across the organization.
  • Considerable experience with Windows computer environment and proficiency with Microsoft Office software.

 

SUPERVISION RECEIVED

Direction is received from the Director of IP Facility Coding, CDI, and Cancer Registry and the Director of OP Facility/Professional Coding.

 

SUPERVISION EXERCISED

Functional and administrative supervision is exercised over Medical Coder Compliance Specialists and the Appeals Coordinator.

Required Qualifications*

  • A Bachelor’s degree in Health Information Management, or other healthcare-related degree.
  • Registration with the American Health Information Management Association as a RHIT, RHIA, certification through the American Academy of Professional Coders as a CPC, or comparable combination of educational preparation and experience in managing health information and providing effective leadership.
  • Three to five years of supervisory experience in Revenue Cycle and/or Health Information Management within a health care setting. 
  • Knowledge of and competence in ICD-10 and CPT coding.
  • Coding leadership experience within a large, fast-paced, and complex health care organization.
  • Thorough knowledge and understanding of how health information is used throughout the organization for patient care, reimbursement, statistical analysis, research, and as the legal record.
  • Skill and experience with influencing and facilitating clinician behavior change.
  • Demonstrated leadership skills and training in leadership as well as knowledge of modern management and High Reliability principles, practices, and methods.
  • Ability to lead, manage, and mentor staff through complex work redesign efforts.
  • Logical, analytical, and organized with the ability to direct and reprioritize work quickly and efficiently.
  • Ability to work in a fast-paced environment under multiple pressures and deadlines.
  • Excellent verbal and written communication skills up, down, and across the organization.
  • Knowledge of third party payer, regulatory, and accreditation requirements.
  • Current membership in the AHIMA and/or AAPC.
  • Considerable experience with Windows computer environment and proficiency with Microsoft Office applications.
  • Excellent organizational, management, planning, interpersonal, written and oral communication skills.
  • Experience in analysis of operations and re-design to improve quality and outcomes
  • Experience and expertise in working with medical staff and medical staff leadership on documentation improvement opportunities.

Desired Qualifications*

  • A Master’s degree or equivalent combination of education and experience.
  • Certified Coding Specialist (CCS) credentials.
  • Knowledge of University and departmental policies and procedures.
  • Experience with benchmarking performance against identified criteria.
  • Experience with Epic, computer-assisted-coding, and 3M applications.
  • Knowledge of hospital billing systems and ADT systems.

U-M EEO/AA Statement

The University of Michigan is an equal opportunity/affirmative action employer.