About the Role
1. Manages the efficient and effective daily operation of the DRG Coding and CDI teams by:
a. Supervising assigned personnel by making hiring recommendations, provides orientation and training, guidance, and professional development as required.
b. Monitoring staffing, work assignments, performance evaluation, time and attendance, and disciplinary activity.
c. Evaluating and establishing productivity and quality standards, and performance monitors.
d. Monitoring the DNFB (Discharged Not Final Billed) accounts, DRG coding and CDI work queues. Addresses workflow issues in a proactive manner.
e. Developing in-service training programs related to DRG coding and CDI for staff.
f. Monitoring activity and performance of vendors and contractors supporting area of oversight.
g. Assisting in the formulation of section's goals, policies, and procedures.
h. Assisting with budget preparation and ensures section operates within its budget by assessing variances.
2. Assuming responsibility for the quality of DRG Coding and CDI through reviews and ongoing education by:
a. Managing internal and external DRG coding and CDI quality reviews. Providing feedback to staff and MHS leadership and implementing action plans to resolve outliers.
b. Managing the payer denials and appeals process within scope. Coordinating coding reviews with contracted services.
c. Reviewing and updating the HIM Coding Compliance Plan and program in response to changing organizational needs or new or revised regulations, policies, or guidelines.
d. Evaluating the quality of clinical documentation to identify incomplete or inconsistent documentation for inpatient encounters that affect the code selection, DRG groups, and payment.
e. Abiding by the AHIMA Standards of Ethical Coding and monitoring coding staff compliance.
f. Ensuring area of responsibility complies with the Center for Medicare and Medicaid Service (CMS) and other regulatory agencies
3. Manages and coordinates the system upgrades and ongoing optimization for the DRG coding and CDI computerized application(s) by:
a. Recommending and implementing new and improved systems, procedures, computerized products, and applications within scope.
b. Evaluating opportunities for system optimization and working with vendor and internal information services staff to enhance system utilization.
c. Demonstrating proficiency with developing and analyzing data reports related to area of managerial oversight.
d. Conducting data and root cause analysis and communicating clinical documentation opportunities and/or concerns to key stakeholders in a timely manner.
4. Acts as the DRG coding and CDI liaison with all related persons/departments within MHS such as, but not limited to Compliance and Ethics, Revenue Cycle, Finance and Decision Support, Center for Quality, Managed Care, MHS Medical Staff, Clinical Registries as well as external stakeholders such as third-party payers and vendors.
a. Serves as the subject matter expert for inpatient coding to include DRGs, ICD-10-CM/PCS and clinical documentation integrity (CDI).
b. Educates medical providers and impacted clinical leadership on areas of DRG coding and clinical documentation.
c. Provides CMI (Case Mix Index) and DRG analyses, inclusive of other required reporting.
d. Serves on hospital committees and work groups requested.
e. Mentors Health Information Management / Technology students.
5. Demonstrates critical thinking skills by challenging the status quo, identifying opportunities, and proposing creative solutions as issues arise.
6. Keeps abreast of ICD-10-CM coding and documentation guidelines, regulations, developments, and practices via continuing education courses, professional organizations, seminars, reading current literature, and maintaining professional contacts in the community; monitors and assesses the appropriateness of emerging trends/strategies, and adopting techniques as deemed appropriate.
Bachelor's degree in Health Information Management or related healthcare field, or any equivalent combination of education, training, and experience in addition to the experience stated below.
One of the following active credentials issued by the American Health Information Management Association (AHIMA):
• RHIA – Registered Health Information Administrator
• RHIT – Registered Health Information Technician
• RN – Registered Nurse with active AHIMA CCS Credential
A minimum of five years experience working with inpatient coding and/or clinical documentation integrity in an acute care hospital setting.
Proficiency with Microsoft Office Suite.
Proficiency with computerized encoder, computer assisted coding and CDI technology.
Analytical ability necessary to conduct basic research, analyze and interpret data, evaluate processes and propose solutions.
Strong leadership and interpersonal skills.
Extensive knowledge of regulations and guidelines pertaining to documentation and inpatient coding.
Ability to prioritize work, meet deadlines, and produce quality results on time with strong attention to detail.
Excellent written and oral communication skills including excellent presentation skills and the ability to communicate. effectively with all levels of management and medical providers.
Must pass a screening coding test during the application process.
Master’s degree in related field.
One or more of the following active credentials:
• CCS (Certified Coding Specialist) - AHIMA
• CDIP (Certified Documentation Improvement Practitioner) – AHIMA
• CCDS (Certified Clinical Documentation and Certification) - ACDIS
May need to move around intermittently during the day, including sitting, standing, stooping, bending, and ambulating.
May need to remain still for extended periods, including sitting and standing.
Ability to communicate in face-to-face, phone, email, and other communications.
Ability to read job related documents.
Ability to use computer.
About the Company
The MetroHealth System, Cuyahoga County’s public health system, and its staff of nearly 8,000 provides care at MetroHealth’s four hospitals, four emergency departments and more than 20 health centers and 40 additional sites throughout Cuyahoga County. The health system is home to Cuyahoga County’s most experienced Level I Adult Trauma Center, verified since 1992, and Ohio’s only adult and pediatric trauma and burn center. As an academic medical center, MetroHealth is committed to teaching and research. Each active staff physician holds a faculty appointment at Case Western Reserve University School of Medicine. Our main campus hospital houses a Cleveland Metropolitan School District high school of science and health. The MetroHealth System is committed to creating a healthier community.