Director, Medical Coding Services
The Director of Coding Services provides the vision, leadership, development, and operational and fiscal management for the regional coding services including professional and hospital coding. Develops, defines, and executes project plans. Accountable for creating a culture of compliance, ethics, integrity and performance.
• Leadership - Provides strategic guidance and direction for the provision of coding services by planning and executing short and long term strategic actions throughout the region supporting the Program's mission, goals, policies and procedures. Creates and manages a strong culture that understands and supports the Program's vision and philosophy. Active leader in the Region's revenue cycle processes to meet defined goals and objectives. Maintains comprehensive knowledge of contemporary coding practices and emerging technology (clinical information systems) to ensure that coding services and infrastructure are progressive and effective. Works closely with other business support departments to coordinate efforts, share best practices and promote consistency in processes. One key area of focus will be in generating the appropriate Risk Adjustment score for the region for Medicare, Medicaid and ACA members.
• Communication - Develops communication strategies and processes for communicating to coding team members as well as senior leadership. Communication needs to include success metrics, project updates, policy changes, system ehancements, etc. Will also need strong communication with national coding leaders for involvement with national initiatives and training.
• Operations - Implements and evaluates organizational structures, policies and personnel management practices to achieve effective leadership and supervision of coding staff for the Region. Ensures the recruitment, training and retention of motivated, competent managers/supervisors. Directs operational activities to improve processes, ensure adequate staffing, with a focus on customer satisfaction. Develops and communicates accountabilities for managers/supervisors and support staff. Provides coaching, counseling, leadership to management to address human resource issues. Meets quality and throughput standards as developed through internal processes. Develops, measures and manages a high performance culture, effectively maintaining a high performing team.
• Quality Management - Establishes, manages and evaluates coding quality. Required to develop a robust quality management program. Achieves compliance with state and federal laws, regulatory agencies, administrative and medical/legal risk assessments and accepted professional practice standards. Evaluates and plans for advanced technology to enhance the quality of coding. Develop vision and strategy for completeness and accuracy of documentation for accurate code capture of diagnoses, procedures and professional services. Leads the organization through changes to meet new industry or governmental requirements.
• Expense/Budget Control - Organizes, manages, assesses, reports and monitors cost effective coding. Manages area of responsibility within budget authority. Maintains an ongoing process to identify, evaluate and implement cost restructuring activities to meet mission and goals.
• Internal Controls-Ensures effective internal controls and SOX compliance for coding management functions.
• Partnering with Labor - Activity participate in labor negotiations, compilation of contract interpretation manual, and provide written or oral documentation of dialogue during labor negotiations. This includes sponsorship of Unit Based Teams (UBTs) and facilitation of process improvement (including issue resolution and grievances).
• Minimum three (3) years plus experience at middle management or director level position with, large hospital system or large Managed Care Organization (MCO).
• Minimum six (6) years in Coding Management including: compliance, operations, and systems.
• Baccalaureate degree in Health Information Management, Health Care Administration, business or related field OR four (4) years of experience in directly related field.
• High School Diploma or General Education Development (GED) required.
License, Certification, Registration
• Professional affiliation with the American Health Information Management Association (AHIMA), the Professional Association of Healthcare Coding Specialists (PAHCS) or AAPC.
• Hold a current coding certification such as a CPC or CCS.
• Demonstrated comprehensive knowledge of contemporary coding practices in a large health care setting.
• Demonstrated thorough knowledge of sound business practices and management principles and techniques (e.g., financial management, strategic planning, personnel management and assessment management).
• Knowledge and experience with state, federal and regulatory agency standards, laws, rules, and regulations with application to health information.
• The ability to make presentations to various professional and public groups in formal, informal, and impromptu situations.
• Ability to respond calmly and professionally in stressful situations.
• Demonstrated ability to strategically plan and prioritize HIM with limited resources.
• Minimum five (5) years experience at director level position with, large hospital system or large Managed Care Organization (MCO).
• Minimum ten (10) years in Coding Management including: compliance, operations, and systems.
• Master's degree in Health Care Administration, business or related field OR six (6) years of experience in a directly related field.
• Current/active Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) credential.
• Current working knowledge of HealthConnect.
• Comprehensive knowledge of managed health care setting, medical and legal, coding compliance.
• Technical knowledge of professional and hospital (technical) coding disciplines.