Manager Coding Quality Education and Training

Under the general supervision of the Senior Manager of Coding Quality, Education and Training (CQET) this Manager is responsible for the management of either the professional coding team or hospital coding team that performs coding quality, education, and training activities. In partnership with key stakeholders, the Manager supports the implementation of Coding & Quality strategy, and continuously works to improve people, process, and technology across the function. Responsible for driving adherence to enterprise coding policies and education functions, including oversight of either the Professional or Hospital coding professionals assigned to the Teams. Through leading edge Quality, Education, & Training Services, this Manager elevates the quality of coding used to drive revenue, and for research, teaching, legal, planning and health care management purposes across the Enterprise. The Hospital CQET Manager is also responsible for operational activities related discharge not final billed activities and interactions with hospital CDI teams in relation to accurate inpatient coding/CDI activities.

Principal Duties and Responsibilities

• Implements and oversees strategies to measure, monitor, improve and validate coding, reimbursement, and related data quality.
• Serves as a resource for MGB department managers, physicians/clinical staff, CDI teams and administration to obtain information or clarification on accurate and ethical coding and documentation standards guidelines and regulatory requirements.
• Provides specialty-based coding educations and documentation improvement initiatives as required.
• Performs routine monitoring in certain highly regulated or high-risk areas to prevent and detect improper claims or other transactions. Conducts internal investigations of changes in coding or billing practices. Initiates corrective action to ensure resolution of problem areas identified during internal monitoring activity.
• Maintains a training curriculum to ensure coding professionals are educated on latest standards, regulations, and techniques in compliance with industry standards and regulations and to accurately reflect revenue captured from Hospital or Professional services provided.
• Manages the coding compliance and audit program to ensure coding quality and compliance. Informs and advises coding team, entity partners and Senior Leadership on regulation change impacts, coding changes and coding audit results.
• Oversees the development and/or update of relevant policies and procedures including the RCO Coding Compliance Manual and all documents and Tip Sheets developed for effective use of CQET related systems.
• Manages and supervises the Audit and Compliance Technical Advisors and Data Quality Specialists within the Hospital audit team or the Coding Education Specialists and QA Coding Specialists within the Professional audit team.
• Ensures all Audit and Compliance activities are appropriately documented
• Evaluates workflows and processes to make recommendations for streamlining work process.
• Manages the administration of program staffing; communicates and completes appropriate documents for Human Resources regarding vacancies, leaves of absence and staff issues. Performs interviews, hiring, supervises, evaluates, counsels, disciplines, and makes recommendations for merit raises, promotions, transfers and/or termination of staff.
• Provides feedback to contract coding management regarding quality review outcomes of vendor coding teams.
• Serves as liaison between Coding and entity CDI and Quality teams and various audit and review committees in the enterprise. Serves on enterprise committees or task forces as required.
• Oversees development of regular communications (emails, newsletter, education Tip Sheets) to current and relevant coding or compliance issues with the goal of promoting awareness to all Enterprise coders.
• Recommends and/or provides coder and/or physician education as required based on audit results.
• Works closely with entity and corporate Compliance departments in monitoring the effectiveness of the Coding Audit and Compliance Program.
• Recommends changes to annual program goals and objectives to leaders that are in alignment with Enterprise Coding and Quality and vision, goals, and objectives.
• Keeps abreast of all developments in the coding, audit and compliance field and continues to improve leadership and management skills through participation in professional activities, continuing education, and other related activities.

Qualifications

• AS or BS in Health Information Technology/Administration or related health care administration program recommended. ICD-10-CM and CPT education required for both the Hospital and Professional Managers
• 5 or more years of broad ranged inpatient coding experience including extensive, ICD-10-CM/PCS and CPT coding experience is required for this Hospital management position. CDI experience a plus.
• 3 or more years strong inpatient and outpatient and/or physician/surgical professional coding experience are required for the Professional management position.
• Minimum 1-3 years’ experience in leading people.
• Experience at an academic medical center preferred.
• Data management experience a plus.
• Credential Qualifications include:
  • AHIMA credentials RHIA, RHIT or CCS, CCS-P required and/or AAPC credentials as CPC or other equivalent AAPC credential in combination with meeting the years of experience and/or educational requirement.

Skills/Abilities/Competencies(Required)

• Experience with computer systems including Coding and clinical data/billing systems is required. EPIC, 3M360, encoder experience a plus.
• ICD-10-PCS and annual review of MS-DRG and APR-DRG updates required for the Hospital Manager as well.
• Extensive Microsoft office experience, especially Word, Excel, PowerPoint, and Outlook.
• Excellent communication and interpersonal skills and ability to communicate effectively with all levels of the organization.
• Experience managing diverse teams, developing team member skills, and achieving shared goals.
• Ability to complete projects within presented timelines and deadlines.
• Ability to manage multiple projects.
• Strong analytical and critical thinking skills.
• Ability to work independently yet remain a collaborator.