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HIM CDI Coding Lead - Full Time

Shift: 8:00am - 4:30pm, Exempt

Telework Days are at the discretion of the Dept. Director, not guaranteed.

Job Description:

PATIENT POPULATION:
The patient population served can be all patients including geriatric, adult, adolescent, pediatric, and newborn. This also includes services which affect facility staff, physicians, visitors, vendors and the general public.
POSITION SUMMARY:
Under the supervision of the Director of Health Information Management, the HIM Coding Lead supervises inpatient and outpatient hospital coding workflow in ICD and CPT assignment. Monitors and assesses performance in coding and CDI staff to assure timely, accurate coding of inpatient discharges, ambulatory surgery encounters, Emergency Department encounters, and diagnostics services and the CDI assessment of inpatient admissions. Assures delivery of coding and CDI staff education and training to insure accurate and thorough coding of encounters with ICD and CPT code sets. Informs, educates, and coordinates with other Revenue Cycle and Clinical operations staff regarding coding and charge capture process for facility encounters.
Must be able to work normal/scheduled working hours to include Holidays, call-backs, weeknights, weekends, and on-call. Agrees to participate, as directed, in emergencies and community disasters during scheduled and unscheduled hours. As a designated disaster service worker you are required to assist in times of need pursuant to the California Emergency Services Act.
(Gov’t. Code §§ 3100, 3102)
Your position has been defined as exempt (Exempt employees are paid on a salary basis as their duties may include more complex tasks that require them to work inconsistent or longer hours on a weekly basis. Exempt salaried employees also may be obligated to work as many hours as required to fulfill their responsibilities.) therefore you may have the ability to work remote as long as your VP has given prior approval. In the event remote work is required 100% of the time or for a defined period of time for a medical accommodation, a full telework agreement must be completed and approved by both your VP and the President/CEO after remote work begins.
Needs to recognize that they have an affirmative duty and responsibility for reporting perceived misconduct, including actual or potential violations of laws, regulations, policies, procedures, or this organization’s standards/code of conduct.
The employee shall work well under pressure, meet multiple and sometimes competing deadlines; and the incumbent shall at all times demonstrate a cooperative behavior with colleagues and supervisors.
EDUCATION/TRAINING/EXPERIENCE:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

A minimum of 2.5 years of acute care hospital inpatient and outpatient coding experience.

Knowledge of anatomy and physiology, disease process and medical terminology. Knowledge of ICD-9 and ICD-10 as well as CPT coding.

Must possess the skill, knowledge, and ability to the successful performance of assigned duties. Previous lead or supervisory experience required.
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence if required. Ability to gather and analyze data and display in appropriate format and maintain accurate records. Effective oral and written English language, communication, and interaction skills in order to interact effectively with all levels of Hospital personnel.

Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages if required. Analytical skills.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. Effective time management skills to permit working in a fast-paced, results-oriented environment. Orientation to detail.

To perform this job successfully, an individual must have computer terminal experience and proficient in business software (including but not limited to Microsoft Office, Word, Excel and E-mail). Knowledge of 3M coding and abstracting software.

LICENSURE/CERTIFICATIONS:
CPC, CCS, RHIA, or RHIT is required.
Responsibilities and Essential Functions:
*Indicates Essential Function
1 * Supervises and performs a wide range of activities pertaining to the review and coding and CDI of inpatient and outpatient medical information.
2 * Establishes, implements and maintains a formulized review process for coding and CDI compliance, including formal review (audit) processes; designs and uses audit tools to monitor the accuracy of clinicl coding.
3 * Performs data quality reviews on inpatient records to validate the ICD, and other codes; verifies Diagnosis related groups (DRG) appropriateness; checks for missed secondary diagnoses and procedures and ensures compliance with all DRG mandates and reporting requirements; monitors Medicare and other DRG paid bulletins and manuals, and reviews the current Office of Inspector General (OIG) work plans for DRG risk aras.
4 Performs data quality reviews on outpatient encounters to validate the ICD, the CPT, and the HCPCS Level II codes and modifier assignments; verifies APC group appropriateness; checks for missed secondary diagnoses and/or procedures; ensures compliance with all APC mandates and outpatient reporting requirements; monitors medical visit code selection against facillity specific criteria for appropriateness; assists in the development of such criteria as needed.
5 * Creates and monitors inpatient case mix reports and the top DRG's in the facility to identify patterns, trends and variations in the facility's frequently assigned DRG groups
6 Acts as a liaison between the medical staff and other departments. Works collaboratively with physicians and other department staff to ensure that clinical information in the medical record is present and accurate so that the appropriate clinical diagnosis and level of severity is captured for the level of service rendered to all patients.
7 * Evaluates and assesses medical records of patients, looks for specificity of an illness, the accuracy of the clinician's documentation, coding requirements and documentation of important medical details to ensure the overall quality and completeness of clinical documentation of the patient medical record.
8 * Acts as a liaison between medical staff, other departments, and the CDI team to relay feedback. Attends onsite meetings in person to represent CDI. Responsible for new hire training. Responsible for running reports. Responsible for denials review when required.
9 * When contacted by Coders concerning disagreements about DRG or incomplete documentation, reviews in Medical Records and follows-up with Physician, if appropriate within a timely manner .Always reviews any issues from all coders In and Out follow up with any an all deparments involved including Physicians and CDI.
10 Reviews chart with HIM Director if unable to reach agreement with Coding Specialist. Director is always involved in any disagreement between coding and CDI and will provide coding clinics and guidelines when applicable.