Full Time
Day
M-F 8a-4p
Position Overview:
The Inpatient Coding Manager&DRG Validator is responsible for overseeing the daily operations of the Health Information Management (HIM) Department, specifically focusing on Inpatient Coding. This role entails managing all processes and procedures related to the abstraction of clinical information from various Electronic Health Records and the assignment of appropriate codes for diagnoses and procedures. The Coding Manager/DRG Validator aims to enhance consistency and efficiency in inpatient claims processing and data collection, optimizing DRG reimbursement and ensuring data quality in hospital inpatient services.
Key Responsibilities:
- Adheres to the hospital’s Performance Standards, Policies, and Behavioral Guidelines.
- Stays updated on all relevant federal, state, and the hospital’s regulations, laws, and policies, both current and amended.
- Ensures staff are trained and assessed on compliance policies and procedures relevant to their roles.
- Guarantees timely submission of coded data to the Patient Accounts Department.
- Acts as a resource for coding and DRG reimbursement within the hospital.
- Oversees compliance reviews, particularly for inpatient cases, and initiates education or corrective actions as necessary.
- Regularly shares findings from coding reviews with coders, facilitating education or corrective actions as needed.
- Ensures compliance with state regulatory and accreditation standards.
- Involved in the hiring, training, evaluation, counseling, and termination of employees following hospital policies.
- Conducts staff meetings to provide updates and address departmental issues.
- Participates in committees, task forces, and projects as required.
- Collaborates with external agencies to implement coding and CDI documentation improvements that promote compliance and revenue growth.
- Manages overall operations within the HIM Department, aligning with hospital goals, overseeing personnel, and monitoring HIM budgets.
- Supports staff in completing work, ensuring adherence to standards, and maintaining accuracy and turnaround times.
- Identifies and implements opportunities to streamline operations, troubleshoot issues, and escalate concerns to higher management when necessary.
- Serves as a positive resource for organizational personnel, fostering goodwill between departments and external parties involved in HIM operations.
- Performs other related duties as assigned.
Education and Experience Requirements:
- Bachelor’s degree required.
- CCS Certification required; RHIA or RHIT credentials preferred.
- Minimum of seven (7) years of coding experience, including at least five (5) years in a management role within an acute care hospital Health Information Department; extensive knowledge of CPT-4 and ICD-10-CM-PCS coding, data entry, and clinical documentation is essential.
- Experience in DRG validation with a strong understanding of coding guidelines and in-depth knowledge of MS-DRG and APR-DRG groupers to ensure optimal compliance and reimbursement.
Core Competencies:
- Ability to foster teamwork among all HIM staff.
- Demonstrates leadership skills and empowers staff to enhance bidirectional communication.
- Excellent organizational, judgment, communication, and problem-solving skills.
- Ability to handle stress effectively during daily operations.
Physical and Mental Demands/Requirements & Work Environment:
- May be exposed to chemicals necessary for job functions; a list of hazardous chemicals is available in the hospital’s Safety Data Sheet (SDS) database, accessible through the hospital’s Intranet (Employee Tools/SDS Access) or at the hospital switchboard.
- Manual dexterity is required for using the computer keyboard and mouse; must be able to sit at a computer terminal for extended periods.
- Ability to walk to various locations both on and off-site.
- Must maintain focus in environments with increased noise levels and temperature changes.