Regional Coding Manager

Schedule Weekly Hours:

- Must have Critical Access Hospital and Rural Health Clinic coding experience

• Work in close collaboration with CAH Revenue Cycle and Operational Lead
  

The Mid-Revenue Cycle Coding Services Manager works under the supervision of the Director to effectively accomplish the duties and responsibilities outlined in Gundersen Health System's Job Charter. Serves Gundersen as an internal expert on the use, interpretation and accurate application of ICD and CPT codes as used for billing, reimbursement, quality measurement, and operations. Contributes to optimum revenue cycle performance through management, oversight, and continuous improvement of the daily operations of professional services coding/charge review and hospital facility coding/charge review to achieve targets. Collaborates with Clinical Documentation Improvement and medical staff leadership to identify needs, develop and deliver education for the medical and associate staff to achieve improved documentation clarity and accuracy reflective of medical necessity, severity of illness, complexity, and risk of mortality.

STRATEGIC RELEVANCE - SUMMARY

To advance its position as an innovator and leading health care system, Gundersen Health System (GHS) must continue to demonstrate superior outcomes, provide seamless delivery of care, and ensure competitive cost structures. It must also stay at the cutting edge of emerging technologies and new delivery models that will transform healthcare. The System must anticipate and respond effectively to evolving market and environmental trends, (e.g., shifts in payment models, value-based purchasing, transparency of outcomes and information technology) that will impact the delivery of health care services.

The Manager is responsible for understanding the impact of these forces and trends and for managing the effective response from their AOR (area-of-responsibility). The Manager collaborates with others to achieve GHS’ strategic mission and goals: 1) demonstrate superior quality and safety through the eyes of patients and caregivers; 2) demonstrate superior service through the eyes of patients and colleagues; 3) attract, develop and retain a talented and engaged workforce; 4) demonstrate affordability of care; and 5) achieve programmatic growth. The Manager translates System strategy into staff commitment, action, and accomplishment in their AOR.

POSITION DUTIES AND RESPONSIBILITIES

The Manager is specifically responsible for:

1.0 Organizational Strategy and Implementation - Understanding market trends and the impact on their AOR, contributing to AOR strategic and operational plans, translating these plans, and ensuring the understanding, alignment and commitment of AOR staff.

2.0 Fiscal Management - Effectively using established processes to ensure accountability for effective operations and resource management.

3.0 Human Resource Management - Effectively using established processes to: select, align, engage, develop, manage, and retain a team of highly skilled staff.

4.0 Excellence in Service and Clinical Quality - Achieving seamless delivery of quality patient care and safety, excellence in patient experience and customer service.

5.0 Organizational Leadership - Providing leadership and accomplishing objectives by ensuring the integration of processes and initiatives while modeling collaboration.

KEY ACCOUNTABILITIES

Organizational Strategy and Implementation

1.1 Collaborates with Division/Team leadership to understand external market financial, economic, and industry data, identifying market opportunities and threats.

1.2 Provides leadership and actively contributes to the design and implementation of clinically and fiscally responsive program goals and objectives for their AOR.

1.3 Formulates recommendations for AOR continuous improvement taking into account market demands, regulatory standards, and changes in clinical practice.

1.4 Establishes clear performance standards for their AOR, and monitors established management systems to ensure that cost effectiveness and continuous quality improvement forms the basis for all activities.

1.5 Collaborates with management to ensure that resources are prioritized and in place (i.e., staff, facilities, equipment, supplies, technology, data, and processes, etc.) and properly utilized to achieve AOR objectives through the most effective and efficient operations.

1.6 Contributes to the development of and implementation of processes to collect relevant clinical and financial indicator data which serves as a reliable proxy for clinical effectiveness, cost, and quality.

1.7 In conjunction with AOR leadership, designs and implements improvement of AOR key processes, leading to elimination of variability in cost and quality.

Fiscal Management

2.1 Manages AOR to meet fiscal targets, ensuring the delivery of cost-effective, quality services.

2.2 Participates in financial forecasting and planning along with other members of the AOR management team.

2.3 Develops and presents comprehensive analysis for financial and programmatic recommendations for AOR management.

2.4 Communicates the rationale for financial decisions ensuring a high level of understanding among staff and clinicians.

2.5 Evaluates AOR for potential cost-effective change and manages the implementation of approved changes.

2.6 Ensures staff compliance, and monitors physician compliance, as appropriate, with financial decisions.

Human Resources Management

3.1 Provides vision and leadership to staff in a collaborative environment that offers job satisfaction, performance recognition, and stimulates innovative thinking to accomplish objectives.

3.2 Ensures that AOR management, staff and clinicians understand their roles in accomplishing GHS, Team/Division, and AOR strategic objectives. Establishes expectations for high level of performance and holds individuals accountable for achieving them.

3.3 In collaboration with other AOR leadership and the Human Resources Department, ensures the efficacy of systems/processes to recruit, retain, and develop a high-performance team that meets patient, regulatory, and fiscal requirements for their AOR.

3.4 In conjunction with Team/Division leadership, ensures staff productivity by maximizing staffing efficiency and workflow patterns as well as monitoring and controlling turnover.

3.5 Implements and actively supports the integration of change and conflict management.

3.6 Creates a climate that ensures respect, teamwork, open communication, and professional recognition among a diverse workforce.

Excellence in Service and Clinical Quality

4.1 Ensures the implementation of service, quality and safety standards consistent with System policy for patient experience and internal and external customers in collaboration with AOR leadership.

4.2 Identifies and analyzes trends across services in customer satisfaction and patient experience, clinical quality outcomes, patient safety and cost using data systematically to develop solutions and guide change in AOR practices.

4.3 Models and ensures that AOR staff effectively uphold a customer service orientation to meet legitimate needs of patients and internal and external customers.

4.4 Ensures that confidentiality of patient, staff, and appropriate management data is maintained, and delivers immediate and certain consequences when confidentiality is compromised.

5.0 Organizational Leadership

5.1 Promotes the organization to all constituencies by interpreting and communicating GHS’ mission and values, acting as a loyal, supportive, and informed spokesperson for AOR, Team/Division and the System.

5.2 Collaborates with other internal professionals to identify, reduce, and eliminate barriers within the system which may negatively impact cost and quality of services.

5.3 In the spirit of collaboration, promotes the visibility of AOR leadership throughout the organization.

5.4 Takes responsibility for providing a positive learning environment for students, interns, and residents working within their AOR, collaborating with academic programs, while ensuring patient safety.

5.5 Takes responsibility for identifying areas for self-development and actively seeks opportunities and resources to meet developmental objectives.

KEY INTERFACES

The Manager interacts primarily with the following external interfaces:

• Patients
• Families

The Manager interacts secondarily with the following external interfaces:

• Payers* scope dependent
• Vendors/Suppliers* scope dependent
• Educational and Regulatory Organizations
• Charitable Organizations
• General Public
• Non-GHS clinicians, hospitals, and facilities

The Manager interacts primarily with the following internal interfaces:

• AOR staff
• Other Team and Functional Managers
• Directors
• Clinicians

The Manager interacts secondarily with the following internal interfaces:

• Other Functional Directors and Managers
• Other System Staff

DECISION MAKING AUTHORITY & RESPONSIBILITY

The Manager has the authority to formulate and execute AOR vision, objectives, and strategies consistent with the System’s mission, vision and goals. This person determines which resources are needed and facilitates the acquisition of additional resources where indicated.

The Manager has the responsibility to advocate change in AOR processes and systems to ensure optimal, cost effective health care delivery. This individual facilitates the resolution of clinical, staff, and policy issues within agreed upon organizational, financial and regulatory limits. The Manager oversees the enforcement of policy, as well as makes recommendations for changes to AOR staff and leadership. The Manager coaches, monitors, and documents staff performance, makes recommendations for compensation strategy and promotion, and supports the physician recruitment process for their AOR.

The Manager represents Gundersen Health System and their AOR within the System and in the external community.

Education and Learning:

REQUIRED

Bachelor's degree in Health Information Management or Medical or Clinical Informatics or Healthcare Administration or Business Administration ICD-10 CM (International Classification of Diseases-Clinical Modification) and PCS (Procedure Classification System) or CPT (Common Procedural Terminology Coding). Please present certificates of completion.

DESIRED

Master's degree in Health Information Management or Healthcare/Hospital Administration or Medical Informatics field of study or a health-related field

Work Experience:

REQUIRED

5-7 years of progressively responsible leadership experience in healthcare as a supervisor of coding or revenue cycle or business office operations. 3-4 years of coding experience, could be professional services or hospital facility services.

DESIRED

5-7 years of experience teaching, auditing, reviewing coding, experience is inclusive of professional services and hospital facility coding.

License and Certifications:

REQUIRED

Valid Driver's License (DL)

Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) or Certified Professional Coder (CPC)

DESIRED

Certified Revenue Cycle Representative (CRCR) from the Healthcare Financial Management Association

Age Specific Population Served:

Nonage Specific (N/A)

OSHA Category:

Category III - No employees in this job title have a reasonably anticipated risk of occupational exposure to blood and/or other potentially infectious materials.

Environmental Conditions:

Not substantially exposed to adverse environmental conditions (as in typical office or administrative work).

Physical Requirements/Demands Of The Position:

Sitting Frequently (34-66% or 5.5 hours)

Walking/Standing Occasionally (6-33% or 3 hours)

Driving Occasionally (6-33% or 3 hours)

Reaching - Shoulder Level Rarely (1-5% or .5 hours)

Reaching - Below Shoulder Occasionally (6-33% or 3 hours)

Reaching - Above Shoulder Rarely (1-5% or .5 hours)

Repetitive Actions - Pinch Forces Rarely (1-5% or .5 hours) Pounds of force 0-25

Repetitive Actions - Fine Manipulation Frequently (34-66% or 5.5 hours)

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I f you need assistance with any portion of the application or have questions about the position, please contact HR-Recruitment@gundersenhealth.org or call 608-775-0267

Equal Opportunity Employer