Coding Quality And Education Manager

Description

Under general direction, plans, develops, and manages Valley Medical Center’s Coding Quality and Education (CQE) Program; develops and implements processes designed to assure high quality performance and accuracy in regard to coding functions within Health Information Management Services (HIMS) and other departments where coding of medical-record documentation is performed; supervises coding and other staff of the CQE Program.

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scvmc.org, oconnor.org, stlouise.org

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Typical Tasks

• Coordinates, monitors, and audits all lines of hospital business for coding, to include: all outpatient, inpatient, ED and Ambulatory surgery cases;
  
• Provides daily oversight and supervision of Coding Quality and Education Program staff;
  
• Serves as resource to VMC staff on medical-record coding and abstracting questions as well as coding-related educational needs;
  
• Develops and/or utilizes assessment methods to determine training/educational needs;
  
• Assures that appropriate training is provided, when necessary, to coders and others engaged in coding-related activity;
  
• Instructs individuals or groups involved with coding-related activity, and performs as facilitator or resource person;
  
• Develop and/or utilizes effective educational tools and Power Point presentations related to the implementation of ICD-10 coding system;
  
• Monitors the accuracy and quality of coding assignments and Present On Admission (POA) indicators, and conducts internal coding audits;
  
• Serves as coding-contact person for HIM Services in conjunction with the Clinical Documentation Analysts in regard to education and coding requirements;
  
• Develops reports of audit results to facility staff and senior management;
  
• Helps set the direction for coding and compliance education and focused projects related to the Electronic Health Record (EHR);
  
• Provides coding staff with oversight and training in relation to Coding-Compliance Software;
  
• Runs audit selection lists and reports and provides education, feedback, and guidance based on data-mining activities and processes;
  
• Provides oversight of the accuracy of data in MIR-Cal—Medical Information Reporting System—for reporting required by the Office of Statewide Health Planning and Development (OSHPD);
  
• Collaborates with the HIMS Director and/or Clinical Documentation Improvement management to assure timely and accurate completion of coding-related work that is consistent with regulatory agency requirements;
  
• Prepares statistical and or annual reports as requested by state or federal agencies or other regulatory agencies, as directed by CDI management;
  
• Ensures compliance with applicable federal, state and local regulations;
  
• Identifies and recommends opportunities to decrease costs and improve service if asked to assist with budget preparation;
  
• Implements changes resulting from internal or external audits which impact collection and reporting of medical records;
  
• May be assigned a Disaster Service Worker, as required;
  
• Performs related work as required.

Employment Standards

Sufficient education, training, and experience to demonstrate the ability to perform the above tasks and possession of the following qualifications, including the knowledge and abilities indicated below:Training and Experience Note: The knowledgeand abilities required to perform this function are typically acquired through training and experience equivalent to graduation from an accredited college or university with a bachelor’s degree in Health Information Management, Business Administration, Health Administration, Nursing, or a related field. AND Five (5) years of acute-care, inpatient, outpatient, DRG (Diagnosis Related Group) and APC (Ambulatory Payment Classifications) coding, and three (3) years supervisory experience in a health information management division. Electronic Health Record experience preferred. Must possess current, AHIMA-approved CCS certification, or be CCS eligible, or possess a current, AHIMA-approved RHIA or RHIT credential.
Knowledge of:

• Principles and methods of program management, staff supervision, and staff development;
  
• Coding, abstracting, and terminology systems such as: International Classification of Diseases 9-Clinically Modified (ICD-9-CM) coding system, CPT-4 procedural coding system, Diagnostic Related Group (DRG) system; and applicable abstracting systems;
  
• The fundamentals of the ICD-10 medical-coding system;
  
• Applicable federal and state regulations as well as The National Committee for Quality Assurance (NCQU), the Joint Commission (TJC), CMRI, and CMS;
  
• Advanced understanding of the learning process as applied to both formal classroom instruction and in-house training methods;
  
• Current adult learning theory and practices, including effective group and individual training techniques;
  
• Principles an techniques of curriculum development and facilitation;
  
• Effective methods of using audiovisual equipment and other training aids or materials;
  
• The abstract patient data fields, abstracting and coding techniques, and statistical methods; and OSHPD reporting requirements;
  
• Comprehensive medical terminology covering a wide variety of medical specialties, including anatomy and physiology and the disease process;
  
• Components and format of the medical record, including but not limited to laboratory findings, special tests, medications, surgical procedures, therapy systems, surgery and other reports, history and progress notes, and consent documentation;
  
• The organization, services, and patient treatment interrelationships and sequences of a comprehensive teaching hospital;
  
• Health Information Management Services procedures;
  
• English grammar, punctuation, and spelling and general English usage;
  
• Computerized patient data systems.

Ability to:

• Plan, organize, coordinate, and supervise a comprehensive medical coding quality and education program;
  
• Effectively translate organizational goals into training goals and curriculum;
  
• Evaluate and assess training needs and program effectiveness;
  
• Develop effective educational tools and Power-Point presentations related to the implementation of ICD-9 and ICD-10;
  
• Provide one-on-one and /or group training to coding staff and others involved in coding-related activities;
  
• Read and comprehend the technical elements of a medical chart;
  
• Analyze, code, and abstract complex technical data from medical records covering a wide variety of medical specialties utilizing an encoder and electronic abstracting system;
  
• Recognize missing elements, infer procedural and treatment relationships., and properly sequence information for coding and abstracting data from a medical record;
  
• Effectively handle the most complicated, involved inpatient and outpatient coding related cases or issues;
  
• Prepare clear and concise narrative, statistical, and graphic reports;
  
• Communicate clearly, both verbally and in writing, with the public, patients, medical, nursing, technical staff, and legal counsel;
  
• Generate reports from computer or manual systems;
  
• Work effectively and harmoniously with others;
  
• Safely perform physical activities such as: reaching over ones head and bending down to retrieve files, standing, pulling records, and/or sitting for long periods of time, periodic lifting moderately heavy file containers (up to 50 pounds) and pushing heavy carts (may be required for some positions).