Director of Coding-CDI-HIM

Best Care•Omaha, NE

7d•Onsite

About The Position

Provides strategic leadership and oversight for revenue cycle operations related to coding, clinical documentation, and health information management across Nebraska Methodist Hospital. Responsible for Clinical Documentation Improvement (CDI), Utilization Management, Tumor Registry, Health Information Management (HIM), and Transcription Services, ensuring regulatory compliance, operational efficiency, and the integrity of the legal medical record. Collaborates with leaders across the revenue cycle, affiliates, legal, and compliance functions to optimize processes, support reimbursement accuracy, and maintain adherence to accreditation and regulatory standards.

Requirements

Requires Bachelor's degree in Nursing, Health Information Management or Healthcare related field.
Minimum of 7-10 years progressive experience in hospital/health care setting.
Minimum of 10 years of management experience.
Recent experience in a hospital, health system or large multi-specialty physician group setting.
Demonstrated track record of mentoring teams resulting in higher level of job satisfaction and performance.
Minimum 5 years' experience managing different components of the Revenue Cycle preferred.
Current valid Registered Nurse (RN) license, valid compact multistate license, or a temporary permit while awaiting licensure required. Or Certified as a Registered Health Information Administrator (RHIA) required.
Knowledge of rules and regulations regarding registration, the legal medical record and release of information.
Proficient DRG, ICD-10, CPT-4 medical record coding, UB04/CMS-1500 claim billing.
Knowledge of revenue cycle accounting concepts.
Proficiency in Health Information Systems, coding technology, and various other system applications related to coding and clinical documentation.
Ability to work independently.
Ability to effectively manage uncertainty and complex situations.
Ability to motivate a high performing team.
Demonstrates a sense of urgency.
Ability to identify, analyze and effectively address complex issues.
Ability to establish positive working relationship with a variety of departments/individuals and promote collaboration.
Position requires a strong positive working relationship with medical staff.

Nice To Haves

Master's degree preferred.

Responsibilities

Oversees coding for Nebraska Methodist Hospitals and hospital based outpatient clinics (System Wide). Manages coding resources, both internal and external, to ensure timely and accurate coding of severity of illness and intensity of services. Perform concurrent coding in collaboration with the Clinical Documentation Improvement team. Manages all coding software, encoders, and other systems applications related to coding. Ensures the coding staff meets or exceed the minimum quality and productivity standards. Ensures coding compliance through periodic internal and external audits. Utilizes current technology for computer assisted coding to improve completeness and accuracy of coding.
Oversees Clinical Documentation Improvement (CDI) working in collaboration with MPC to facilitate further expansion. Ensure clinical documentation team performs assigned daily new and recurring reviews, completes physician queries, provides physician education and works with coders to ensure an accurate DRG assignment. Maintains a strong clinical documentation team with the ability to interact one-on-one with physicians. Facilitates physician education to assure documentation accurately reflects illness severity and utilization of resources. Manages in-service training of staff, quality reviews, and new physician or other clinical practitioner program orientation programs as needed. Advocates and facilitates best practice models for securing clinical documentation, linking the most accurate capture of documented care to the most accurate codes. Monitors trends in service line case mix index and cc/mcc capture rates for potential physician and coder education opportunities.
Oversees Utilization Management (Methodist Hospital & Women's Hospital). Works collaboratively with payors to obtain and, when necessary, extend payor authorization for third-party coverage. Provides clinical review information based on the patient's condition, plan of care and treatment. Manages OPTUM Onsite Physician Advisor Services (OPAS) to monitor program effectiveness and impact on reimbursement. Collaborates with clinical areas focusing on length of stay reduction. Monitors medical necessity denials identifying root cause and works in collaboration with denials management team, payers and providers on opportunities to mitigate further denials. Works with the Clinical Denials and Appeal Unit to investigate denials and support appeals. Coordinates and facilitates leadership committees to include but not limited to: Concurrent Review Committee (Methodist Hospital & Women's Hospital), Clinical Documentation Excellence (CDE) Steering Committee and Length of Stay Steering Committee. Drafts agenda and plans monthly/quarterly meetings in coordination with Committee Chair(s) and Leadership.
Oversees Transcription Services. Ensures health system defined quality standards for accuracy and turnaround times are met. Ensures productivity and quality standards to maintain the accuracy and completion of. Oversees 3rd party vendor relationship to support organizational goals and HIPAA compliance.
Oversees Health Information Management (Excluding Coding) Oversees the management of the Master Patient Index in accordance with regulatory standards. Collaborates with compliance and legal teams to oversee the overall management of the legal medical record for the organization in accordance with accreditation and regulatory standards. Oversees all organization and vendor staff related to confidential release of patient health information, quality review, record processing.
Supports management of the Methodist Hospital Cancer Registry. Works collaboratively with Methodist Jennie Ed and Methodist Fremont Health Tumor Registries, providing staff and system support, as warranted. Coordinates implementation and maintenance of multi-facility database across the enterprise. Ensures accreditation body standards are met, information is available to the cancer committees and teaches programs. Ensures cancer data is abstracted on all patients who meet criteria for submission of data to State and National cancer registries and/or agencies.
Works in collaboration with the Department of Health and Human Services (DHHS) to meet contractual agreements for support of the State Cancer Registry. Ensures appropriate and timely reports are provided to regulatory agencies to assure timely and accurate data submission.