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 and Clinical Documentation Integrity services for the hospital and its provider clinics. The role is accountable for complete, accurate and timely coding and documentation to support clean claims, appropriate reimbursement and controlled unbilled (DNFB) balances. The manager also safeguards the confidentiality, integrity and availability of the legal health record and ensures compliance with federal, state, accreditation and payer requirements. The manager leads coding operations across inpatient, outpatient, emergency, observation and provider clinic services; oversees the inpatient CDI program; manages coding and documentation denials, audits and appeals; and ensures timely completion of physician records. The position also oversees provider-clinic health record practices, release of information, privacy, records management, data and technology initiatives, and departmental staffing and financial management. The role develops and monitors HIM and CDI policies, performance measures, department goals and budgets; recruits, trains, develops and evaluates staff; and keeps hospital administration informed about department activities, performance, risks and needs. The manager is expected to maintain required credentials and continuing education and to demonstrate the organization’s stated service behaviors.

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 experience in Health Information Management, including inpatient and outpatient coding or CDI.
Four years of supervisory or management experience.
Maintain required credentials and continuing education, including the manager’s AHIMA credentials.
Adhere to the organization’s Service Standards of Behavior.

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

Plan, budget, organize and direct Health Information Management and Clinical Documentation Integrity services for the hospital and provider clinics.
Direct inpatient, outpatient, emergency, observation and provider-clinic coding operations, and establish coding productivity and accuracy standards.
Set and report measurable unbilled targets, including DNFB dollars and days, coding turnaround and accounts held for coding; maintain escalation processes for coding holds and documentation delays.
Conduct internal coding audits, coordinate external audits, implement code-set updates with education and system updates, and resolve coding-related claim edits with Revenue Cycle and the Charge Description Master function.
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 follow AHIMA/ACDIS query practice guidelines; monitor and report CDI metrics; and educate physicians, advanced practice providers and clinical staff.
Manage coding and clinical documentation denials, prepare or oversee appeals, coordinate external audit and record-request responses, and report denial trends and corrective actions to revenue cycle leadership monthly.
Track provider record deficiencies for the hospital 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 education and standardized scanning, indexing, release-of-information and retention processes.
Ensure documentation and billing support meet the requirements of each clinic’s designation.
Fulfill patient right-of-access requests 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; and partner with the Compliance Officer on access audits, breach investigations and privacy education.
Maintain Master Patient Index integrity, including duplicate identification, record merges and overlay correction; maintain legal health record and designated record set definitions and retention and destruction schedules; 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.
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 and revise HIM and CDI policies and procedures; and ensure compliance with applicable 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 supportiveness, etiquette, respect, vibrancy, integrity, communication and excellence in service delivery in accordance with the Service Standards of Behavior.