Director of Coding - Health Information - F/T Days

University of California, Irvine•Orange, CA

About The Position

The Director, Coding is responsible for the operational leadership and management of all inpatient and outpatient coding functions. The incumbent is accountable for the clinical quality, operational performance, regulatory and payer compliance, and financial management of coding services, encompassing ICD-10-CM/PCS diagnosis and procedure coding, CPT coding, DRG validation and optimization, coding quality and audit functions, coding compliance, and clinical documentation integrity. This role directs departmental activities to ensure coding services are delivered accurately, efficiently, and in alignment with health system standards, regulatory requirements, and organizational objectives, supporting the integrity of the medical record, revenue cycle performance, and compliance with all applicable federal and state coding and billing guidelines. The Director serves as the primary subject matter expert and operational resource for all matters related to inpatient and outpatient coding, coding compliance, payer requirements, and coding technology systems, and collaborates with clinical, physician, HIM, compliance, revenue cycle, and administrative leadership on coworker development, technology and information systems planning, denial management, coding accuracy improvement, and performance improvement initiatives. This position provides direct oversight and serves as a role model and primary resource to coworkers and others, maintaining accountability for departmental performance and the financial integrity of coding operations. The Director exercises wide latitude of authority in managing facility-level and operational coding functions with limited oversight.

Requirements

Must possess the skill, knowledge, and ability essential to the successful performance of assigned duties
Must demonstrate customer service skills appropriate to the job
Must be CCS Certified and have detailed coding experience
Bachelor’s degree in Health Information Management or related field and/or equivalent experience/training
Ability to maintain a work pace appropriate to the workload
Ability to leverage technology to create greater efficiencies and establish related tracking and audit procedures
7 years related work experience with extensive management experience in ICD-10-CM, DRG and CPT-4 coding of inpatient and outpatient records in an acute care facility and experience in using a computerized abstracting, encoding, and database systems
Minimum 5 years’ experience of progressive management responsibility
Minimum of 3 year experience in an management leadership role

Nice To Haves

Strong knowledge of the ICD-10 Official Coding Guidelines for Coding and Reporting, UHDDS definitions, AMA CPT and Modifier rules, bundling rules and documentation requirements for medical necessity set forth in associated Medicare NCD or LCD’s
Project management and advance software skills
Possesses broad knowledge of various medical specialties and appreciates the complexities of subspecialty coding practices
Knowledge of CMS’s HCC hierarchies and risk adjustment models and HEDIS reporting, ROI
In-depth knowledge of professional clinical coding & reimbursement topics and experience with electronic medical records
Knowledge and experience with compliance query guidelines, denial management and price transparency requirements
Familiar with Population Health-based metrics, including PQRS, MIPS and VBM merit-based incentive payment systems
Excellent leadership and fiscal management skills and ability to create a goal-oriented climate of teamwork, collaboration, and consistent achievement of objectives
EPIC expertise and knowledge, including Coding and workflow routing as related to EPIC
Demonstrates advanced written and verbal English communication, interpersonal, organizational, analytical, and presentation skills
Demonstrated excellent critical thinking and problem-solving abilities, including the ability to assess and evaluate operations, produce and interpret reports, develop new policies and strategies, and implement plans
Demonstrated ability to present to large groups/conferences (such as AHIMA)

Responsibilities

Operational leadership and management of all inpatient and outpatient coding functions
Accountable for the clinical quality, operational performance, regulatory and payer compliance, and financial management of coding services, encompassing ICD-10-CM/PCS diagnosis and procedure coding, CPT coding, DRG validation and optimization, coding quality and audit functions, coding compliance, and clinical documentation integrity
Directs departmental activities to ensure coding services are delivered accurately, efficiently, and in alignment with health system standards, regulatory requirements, and organizational objectives
Supports the integrity of the medical record, revenue cycle performance, and compliance with all applicable federal and state coding and billing guidelines
Serves as the primary subject matter expert and operational resource for all matters related to inpatient and outpatient coding, coding compliance, payer requirements, and coding technology systems
Collaborates with clinical, physician, HIM, compliance, revenue cycle, and administrative leadership on coworker development, technology and information systems planning, denial management, coding accuracy improvement, and performance improvement initiatives
Provides direct oversight and serves as a role model and primary resource to coworkers and others
Maintains accountability for departmental performance and the financial integrity of coding operations
Exercises wide latitude of authority in managing facility-level and operational coding functions