Manager, Inpatient Coding amp; Clinical Documentation Integrity Services

HYBRID ROLE

Scope of Position

The Manager of Inpatient Coding amp; Clinical Documentation Integrity Services is responsible for managing systems and operations for efficient coding of inpatient medical record information from University Hospital. East Hospital, Brain and Spine Hospital, James Hospital, Ross Heart Hospital, Harding Hospital, Talbot Hall, and Dodd Hall. The manager monitors ICD-10-CM/PCS code assignments and data entry for inpatient and rehabilitation prospective payment systems (MS-DRGs and APR-DRGs). Monitors computerized medical record information systems, i.e., IHIS and 3M Encoder. In this role, the Inpatient Coding amp; Clinical Documentation Services Manager serves as a liaison and coordinator for special projects regarding the coding of medical records.

This position is critical to the financial standing of the hospital. Under the prospective payment system, the accuracy of the coding of diagnoses and procedures and the timeliness of their provision to the billing system will determine if the hospital will receive the full and proper payment from Medicare, Medicaid, CHAMPUS, and other third-party payers.

This position is critical to the reputation of the hospital. The hospital is obligated to report accurate codes reflecting physician documentation for billing purposes. The Manager trains coders and monitors coders' performance to assure accurate and compliant coding.

The Manager of Inpatient Coding amp; Clinical Documentation Integrity Servicesworks to strategically plan, organize, implement and re-evaluating processes to keep staff engaged and to assist in meeting department and organizational goals for the documentation integrity program at OSUWMC. This includes ensuring the documentation in the medical supports the case mix index (CMI), severity of illness (SOI), risk of mortality (ROM), hierarchical coding categories (HCC) as well as quality initiatives such as patient quality indicators (PSI) and hospital acquired conditions (HAC).

To achieve these goals and financial metrics, the manager works in collaboration with various health system operational leaders.

Position Summary

This role serves as the manager for inpatient coding amp; clinical documentation integrity services. This team is vital to the continued operation of the entire department as it serves to assign the codes necessary for the billing of the inpatient accounts. The manager sets forth daily priorities for staff, monitors accounts that are not resolved, and makes suggestions for change to the Director of Coding, CDI, and Compliance. They support coding specialists in assigning ICD-10-CM/PCS diagnoses and procedure codes. They also determine Medicare Severity Diagnosis Related Group (MS-DRG) and All Patient Refined Diagnosis Related Groups (APR-DRG) for billing and statistical purposes. The manager monitors performance to assure compliance with policies and procedures and billing rules. Also, the manager of inpatient coding keeps detailed records of all audits conducted, the results, recommendations, and follow-up to assure action is taken. The manager develops training materials and conducts training sessions with the coding quality analysts, coders, and students. The leader of this team must constantly interact with Department Administration, Department Managers, medical staff, medical staff secretaries, medical and nursing students, nursing, and unit clerical associates.

The purpose of the clinical documentation integrity program is to ensure quality patient care is documented in the medical record. The documentation in the medical record reflects the accuracy of coding and Medicare Severity Diagnosis Related Group (MS-DRG)/All Patient Refined Diagnosis Related Groups (APR-DRG) assignment. Clinical Documentation Integrity specialists validate present on admission indicators and coding of diagnoses that influence the severity of illness and risk of mortality scores. Clinical Documentation Integrity Specialists serve as partners to the clinical and business departments of the health system and is used to support patient care, patient safety, teaching, research, hospital operations, quality assurance, and reimbursement.

Minimum Qualifications

For Hire:

Bachelor's degree in Health Information Administration or equivalent degree required. Master's degree in Business Administration, Computer and Information Science, or Public Administration preferred.

Considerable progressively responsible administrative medical information management experience requiredknowledge and experience with electronic health records and health information management applications required.

Candidate must possess one of the following certifications: Registered Health Information Record Technician (RHIT), Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS) by the American Health Information.

A minimum of two years of coding experience or3 years of experience requiredworking as a Clinical Documentation Integrity specialist or a comparable positionis required. Previous management experience preferred.

Work experience in an acute care setting required. Experience with medical record coding conventions (ICD-10-CM/PCS) and data analysis is required.

Excellent inter-personal communication skills required for interactions with physicians, nursing staff, case managers and other hospital personnel. Strong critical thinking skills, and ability to assess, evaluate and teach members of the healthcare team.

Knowledge and experience with medical information computer applications, word processing and electronic spreadsheets.

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