Director of Coding and Clinical Documentation Integrity

Mercyhealth Wisconsin and Illinois • Janesville, WI

9d • Onsite

About The Position

Oversees and monitors the HIM coding program, Professional coding program including appropriate documentation, accurate coding, and adherence to hospital and regulatory policies and guidelines for all appropriate personnel including HIM coding staff, physicians, billing personnel, and ancillary department support. Serves as a resource for department managers, staff, physicians, and administration to obtain information or clarification on accurate and ethical coding and documentation standards, guidelines, and regulatory requirements. Develops and coordinates appropriate training materials, conducts in-services, and/or ensures the appropriate dissemination and communication of all regulations, policies, and guideline changes to affected personnel. Conducts trend analyses to identify patterns and variations in coding practices and case-mix index. Compares coding and reimbursement profiles with national and regional norms to identify variations requiring further investigation. Reviews claim denials and rejections pertaining to coding and medical necessity issues and, when necessary, implements corrective action plans, such as educational programs, to prevent similar denials and rejections from recurring. Identifies required enhancements in technology platforms to improve the accuracy and efficiency of coding. Reports noncompliance issues detected through auditing and monitoring, the nature of corrective action plans implemented in response to identified problems, and the results of follow-up audits to the Senior Director Of Revenue Cycle. Participates in hiring, evaluation, and disciplinary action according to client policies and under client's direction.

Requirements

• Bachelor's Degree in a related field (Business Administration, etc.,) or equivalent experience
• 7 - 10 years' experience in Healthcare Administration, Coding, , and/or Provider Services
• Experience managing/supervising employees.
• Demonstrated adaptability and flexibility to changes and response to new ideas and approaches.
• Excellent communication and interpersonal skills to include the ability to negotiate and resolve conflicts and build teams.
• Demonstrated creativity and flexibility.
• Ability to operate in high-pressure situations.
• Excellent organizational skills.
• Demonstrated innovative approach to problem resolution.
• Ability to work collaboratively across entities and disciplines.
• Broad knowledge of modern health care administration practices and principles within a managed care environment and/or a vertically integrated delivery system.
• Effective analytical abilities to develop and analyze options, recommend solutions to and solve complex problems and issues.
• Ability to function independently and deal with multiple, simultaneous projects.
• Ability to recognize personal strengths and weaknesses and develop goals for professional growth and achievement.
• Ability to implement change in a positive, sensitive and forward- thinking manner.
• Demonstrates the ability to persuade others and develop consensus.
• Ability to ensure a high level of customer satisfaction including employees, patients, visitors, faculty, referring physicians and external stakeholders.

Nice To Haves

• Certification and Licensure N/A

Responsibilities

• Oversees and monitors the HIM coding program, Professional coding program including appropriate documentation, accurate coding, and adherence to hospital and regulatory policies and guidelines for all appropriate personnel including HIM coding staff, physicians, billing personnel, and ancillary department support.
• Serves as a resource for department managers, staff, physicians, and administration to obtain information or clarification on accurate and ethical coding and documentation standards, guidelines, and regulatory requirements.
• Develops and coordinates appropriate training materials, conducts in-services, and/or ensures the appropriate dissemination and communication of all regulations, policies, and guideline changes to affected personnel.
• Conducts trend analyses to identify patterns and variations in coding practices and case-mix index.
• Compares coding and reimbursement profiles with national and regional norms to identify variations requiring further investigation.
• Reviews claim denials and rejections pertaining to coding and medical necessity issues and, when necessary, implements corrective action plans, such as educational programs, to prevent similar denials and rejections from recurring.
• Identifies required enhancements in technology platforms to improve the accuracy and efficiency of coding.
• Reports noncompliance issues detected through auditing and monitoring, the nature of corrective action plans implemented in response to identified problems, and the results of follow-up audits to the Senior Director Of Revenue Cycle.
• Participates in hiring, evaluation, and disciplinary action according to client policies and under client's direction.
• Directly supervises hospital coding and professional coding and CDI teams.
• Supervises employees in accordance with directives of management, the organization's policies, and applicable laws.
• Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems; employee adherence to annual education and certification requirements.

Benefits

• Medical, Dental, Vision
• Life & Disability Insurance
• FSA/HSA Options
• Generous, accruing paid time off
• Paid Parental and caregiver leave
• Career advancement and educational opportunities
• Tuition and certification reimbursement
• Certification Reimbursement
• Well-being Programs
• Employee Discounts
• On-Demand Pay
• Financial Education
• Annual recognition/awards events
• Partner appreciation days
• Family entertainment/attractions discount
• Community service/improvement opportunities

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 501-1,000 employees