ASSOCIATE DIRECTOR HIM CLINICAL CODING
To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values—integrity, patient-centered, respect, accountability, and compassion—must guide what we do, as individuals and professionals, every day.
Reporting to the Executive Director, HIM and Coding this position will assist the Executive Director by being directly responsible for HIM Coding. This position is responsible for implementing the established strategic direction for the provision of coding services by executing short and long term strategic actions across the Yale New Haven Health (YNHH) System. This position is responsible to provide day-to-day oversight of operations and fiscal management for the System coding services. The Associate Director (AD) is responsible for system implementations, interviewing, hiring and training employees, planning, assigning and directing workflow, appraising employee performance and resolving problems along with proactively managing production and quality control efforts. The Coding AD is accountable for ensuring a culture of coding compliance ethics, integrity and performance.
- 1. Develops long range and short term goals, objectives, plans, programs and assures the implementation of these.
- 2. Oversees the successful implementation of 3M 360 technology that results in workflow improvements, provides for coding innovations and enhances coding, documentation and query resolution in a timelier manner.
- 3. Monitors unbilled account reports on a daily basis for outstanding services or un-coded discharges to reduce accounts receivable days for inpatients and/or outpatients.
- 4. Implements Outpatient and Emergency Department coding, documentation improvement and revenue integrity compliance analysis and program oversight. Ensures E/M accuracy for Emergency Department professional and technical levels and CPT and HCPCS accuracy.
- 5. Oversees daily operations of Coding Division including work load and staffing; hiring, disciplining and performance appraisals and monitors quality and training of all coding employees at YNHH.
- 6. Oversees the development of coding policies, procedures and guidelines. This includes the maintenance of the coding compliance manual for HIM Coding.
- 7. Within the division conducts trend analysts to identify patterns and variations in coding practices, case-mix-index, patient safety indicators and DRG denials and other factors influencing overall ranking of YNHH.
- 8. Establish a Coding Recruiting and Retention Program that ensures a coding staff that possesses a solid coding knowledge base and certification.
- 9. Responsible for the ongoing monitoring of ICD-10 status post implementation. Ensure post go-live metrics related to coding productivity and quality is monitored and meet candidate for billing metrics.
- 10. Compares coding and reimbursement profile with national and regional norms to identify variations requiring further investigation.
- 11. Reviews claim denials and rejections pertaining to coding and medical necessity issues and, when necessary, implements corrective action plans to prevent similar denials and rejections from occurring.
- 12. Oversight of DRG Payer Audits Division and implements integrations with inpatient coding function to ensure timely responses, appropriate appeals process, optimum workflow and ongoing remediation of DRG denials through corrective actions plans to prevent similar denials from recurring.
- 13. Works collaboratively with a wide variety of staff and management who strongly impact coding including Corporate Compliance, Billing, Revenue Integrity, Clinical Documentation Improvement and ITS.
- 14. Develops communication strategies and ensures ongoing communication with remote coders. Communication addresses success metrics, project updates, policy changes, system enhancements and regulatory changes.
- 15. Prepares administrative reports as requested and serves as expert resource for YNHHS in prospective payment systems, such as MS-DRGs, APR-DRGs and APCs.
Bachelor's degree in Health Information Management. RHIA or RHIT required. Master's degree is desirable.
Six to Eight years progressive work experience in a managerial responsibility for coding that includes the planning and preparation for ICD-10 implementation. Extensive knowledge and experience with ICD-9-CM, ICD-10 and CPT coding principles and guidelines. Applicant must possess strong revenue cycle experience working closely with the Billing Office, Revenue Integrity and Clinical Documentation Improvement. Demonstrated accomplishments for revenue cycle initiatives.
Project Management Certification or project management experience managing large projects required. Expert knowledge of ICD-10-CM, CPT and HCPC coding, DRGs and APCs. Understanding of current billing and regulatory requirements, including federal compliance regulations and coding guidelines. Strong managerial, leadership and interpersonal skills. Must possess ability to work with revenue cycle enhancements. Excellent interpersonal and presentation skills. Well developed communication skills, analytical skills, and use of Microsoft Office tools. Strong knowledge of systems. Ability to work with a diverse group of clinicians, ancillary departments, and office staff.
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