Health Information Mgt Manager

Opelousas General Health System•Opelousas, LA

About The Position

The Health Information Management Manager plans, budgets, organizes, and directs Health Information Management (HIM) and Clinical Documentation Integrity (CDI) services for the hospital and its provider clinics. The role is accountable for complete, accurate, and timely coding and documentation that support clean claims, appropriate reimbursement, and control of the unbilled (DNFB) balance. It also safeguards the confidentiality, integrity, and availability of the legal health record and ensures compliance with federal and state requirements, accreditation standards, and payer rules. The manager leads coding operations across inpatient, outpatient, emergency, observation, and provider-clinic services; directs the inpatient CDI program; oversees coding and documentation denials, audits, appeals, and physician record completion; and manages health records, release of information, privacy, and records processes across the hospital and clinics. The role serves as the HIM lead for EHR and related technology, develops performance reporting, and manages departmental staffing, policies, goals, and budget. The position is primarily office-based and sedentary, with regular computer use. Bloodborne pathogens, chemicals, airborne communicable diseases, extreme temperatures, and noise exposure are not anticipated.

Requirements

Bachelor's degree in Health Information Management or a related field.
Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT) with a bachelor's degree and significant HIM leadership experience.
Five years of Health Information Management experience, including inpatient and outpatient coding or CDI.
Four years of supervisory or management experience.
Maintain AHIMA credentials and ensure staff maintain required credentials and continuing education.
Demonstrate supportiveness, etiquette, respect, vibrancy, integrity, communication, and excellence in service delivery.

Nice To Haves

Master's degree in HIM, Health Administration, or Business.
CCS, CDIP, or CCDS, and/or CPC certification.
Physician practice or clinic coding and documentation experience.
Oracle Health (Cerner) EHR and encoder systems experience.

Responsibilities

Direct inpatient, outpatient, emergency, observation, and provider-clinic coding operations, including applicable DRG, APC/OPPS, CPT, HCPCS, E/M, and HCC coding.
Set and report unbilled targets, including DNFB dollars and days, coding turnaround, and aging of accounts held for coding; maintain an escalation process for coding holds and documentation delays.
Set and enforce coding productivity and accuracy standards; conduct internal coding audits and coordinate external audits.
Implement annual and quarterly code-set updates, including education and system updates.
Partner with Revenue Cycle and the Charge Description Master (CDM) function to resolve coding-related claim edits.
Manage outsourced and remote coding vendors, including contract terms, performance targets, and audit results.
Lead the inpatient CDI program and support accurate HCC risk-adjustment documentation for Medicare Advantage and other value-based populations.
Ensure physician queries comply with AHIMA/ACDIS query practice guidelines; monitor and report CDI measures, including case mix index, CC/MCC capture, severity of illness, risk of mortality, query volume, response rate, and agreement rate.
Provide documentation education to physicians, advanced practice providers, and clinical staff.
Manage coding and clinical documentation denials, including DRG downgrades, medical necessity denials, and coding-edit denials; prepare or oversee appeals.
Coordinate responses to external audits and record requests, including RAC, MAC/TPE, UPIC, OIG, Medicare Advantage, and Medicaid managed-care audits, in conjunction with the RAC Auditor.
Track denial root causes and report trends and corrective actions monthly to revenue cycle leadership.
Manage provider record-deficiency tracking and enforce Medical Staff Bylaws and Rules and Regulations for timely completion and authentication of records.
Maintain delinquent records at or below The Joint Commission threshold and report delinquency to the Medical Executive Committee.
Oversee documentation, coding, and health-record standards for system-owned provider clinics, including E/M guideline education.
Standardize scanning, indexing, release-of-information, and record-retention processes across locations; ensure documentation and billing support meet each clinic's designation requirements.
Ensure patient right-of-access requests are fulfilled within HIPAA timelines and comply with 21st Century Cures Act information-blocking rules, including patient portal access.
Manage subpoenas, court orders, legal holds, amendment requests, and accounting of disclosures; oversee release-of-information vendors.
Partner with the Compliance Officer on access audits, breach investigations, and privacy education.
Maintain Master Patient Index integrity, including duplicate-record identification, merges, and overlay correction.
Maintain the legal health record definition, designated record set, and record-retention and destruction schedules in accordance with Louisiana law and federal requirements; oversee birth-certificate and vital-record processing.
Serve as HIM lead for EHR optimization, encoder and computer-assisted coding tools, document imaging, and EHR downtime procedures.
Evaluate emerging technologies, including AI-assisted documentation and coding, for accuracy, compliance, and return on investment.
Produce a monthly HIM dashboard covering DNFB, coding turnaround, coding accuracy, delinquent records, release-of-information turnaround, CDI metrics, and coding-related denials.
Keep hospital administration informed of departmental activities, performance, risks, and needs.
Develop, implement, and revise HIM and CDI policies and procedures, ensuring compliance with The Joint Commission, CMS Conditions of Participation, Louisiana Department of Health, and other regulatory requirements.
Set annual department goals aligned with the hospital strategic plan and monitor progress.
Staff the department to productivity standards; recruit, hire, train, develop, and evaluate staff.
Prepare and manage the department operating budget, including vendor and outsourced coding costs.
Ensure staff maintain required credentials and continuing education, and maintain the manager's own AHIMA credentials.
Demonstrate the service behaviors of supportiveness, etiquette, respect, vibrancy, integrity, communication, and excellence in service delivery.