Overview: The Health Information Management Coding Manager provides day-to-day oversight, direction and management for the hospital inpatient, hospital outpatient or professional fee coding functions at Carle. The Coding Manager ensures the quality, accuracy and timeliness of all the coding completed within Health Information Management. The position is responsible for planning, analyzing and development of operations, procedures and processes with respect to coding. Position also acts as a liaison and consultant for other departments with respect to coding and coding regulatory requirements. The coding manager is responsible for yearly cost center budgeting and advises the HIM Director in the area of coding, coding education, coding software, coding staffing and budgeting. The coding manager is responsible to ensure appropriate staffing for all areas coded by Health Information Management Responsibilities:

• Communicates effectively with internal and external customers
• Identify and resolve issues regarding billing, reimbursement, coding, audits or case mix index.
• Conducts regular audits and ongoing monitoring of coding accuracy
• Provides feedback and focused educational programs on the results of auditing and monitoring activities to affected physicians and organizational staff.
• Reports coding quality and accuracy regularly according to HIM policy.
• Supervises and manages all inpatient, outpatient and professional fee coding activities and staff for The Carle Foundation and Hoopeston Regional Health Center.
• Directly assists and mentors all clinical staff, administration, department managers and compliance staff regarding information or clarification of accurate and ethical coding standards, guidelines and regulatory requirements.
• Ensures the appropriate dissemination of regulatory or compliance guidelines and changes related to coding.
• Ensures proper coordination between Concurrent Clinical Documentation Specialists, inpatient coders, outpatient coders, physician coders, physician advisors, vendors that provide coding services, physicians, nurses, and other ancillary staff to identify and record principal and secondary diagnoses, principle and secondary procedures, and assignment of the working DRG.
• Manages HIM physician advisors to ensure flow of queries and chart reviews.
• Utilizes appropriate tools to track productivity, quality and timeliness of coding programs, interprets findings and reports them to Health Information Management Director and hospital administration.
• Hires and trains coding staff to ensures coding team provides timely, accurate and high-quality coding while optimizing revenue and maintaining compliance through varied venues and tasks (auditing, education and training).
• Serves as the Carle point person for questions regarding coding.
• Attends meetings regarding this area as needed.
• Maintains internal controls and management reports to monitor accounts receivables, productivity and quality.
• Maintains AR days under 5.
• Reviews and follows up on all PRO/Insurance review correspondence related to medical record documentation and coding.
• Reviews all DRG changes/denials and prepares letters of correspondence/appeal when needed.
• Works with RAC coordinator on all government audits and reviews.
• Provides input and follow up as needed for any payer specific coding audits and reviews.
• Maintains active involvement in all regulatory compliance functions by maintaining up to date working knowledge of latest healthcare trends in coding, reimbursement and clinical care management.
• Works with the EMR team to ensure record compliance with State and Federal Laws.
• Responsible for preparing and managing budgets for all coding areas

Qualifications:

EDUCATION:

• Bachelor’s Degree: Related Field

WORK EXPERIENCE:

• Coding - 5 years
• Supervisory or Management - 3 years

SPECIALIZED KNOWLEDGE AND SKILLS REQUIREMENTS:

• Strong background in CPT, HCPCS and ICD coding
• Relevant regulatory requirements for coding.
• Demonstrated excellent written and verbal communication skills.
• Working knowledge of healthcare payment systems.
• Ability to work with physicians and staff at all levels.
• Ability to function as an educator and advisor to physicians and staff.
• Working knowledge of Microsoft office, Computer Assisted Software and Encoders.
• Working knowledge of state and federal requirements for healthcare billing.
• Critical thinking and organizational skills required.
• Requires the ability to plan and schedule to meet deadlines.
  Carle Health Company Overview:

• Communicates effectively with internal and external customers
• Identify and resolve issues regarding billing, reimbursement, coding, audits or case mix index.
• Conducts regular audits and ongoing monitoring of coding accuracy
• Provides feedback and focused educational programs on the results of auditing and monitoring activities to affected physicians and organizational staff.
• Reports coding quality and accuracy regularly according to HIM policy.
• Supervises and manages all inpatient, outpatient and professional fee coding activities and staff for The Carle Foundation and Hoopeston Regional Health Center.
• Directly assists and mentors all clinical staff, administration, department managers and compliance staff regarding information or clarification of accurate and ethical coding standards, guidelines and regulatory requirements.
• Ensures the appropriate dissemination of regulatory or compliance guidelines and changes related to coding.
• Ensures proper coordination between Concurrent Clinical Documentation Specialists, inpatient coders, outpatient coders, physician coders, physician advisors, vendors that provide coding services, physicians, nurses, and other ancillary staff to identify and record principal and secondary diagnoses, principle and secondary procedures, and assignment of the working DRG.
• Manages HIM physician advisors to ensure flow of queries and chart reviews.
• Utilizes appropriate tools to track productivity, quality and timeliness of coding programs, interprets findings and reports them to Health Information Management Director and hospital administration.
• Hires and trains coding staff to ensures coding team provides timely, accurate and high-quality coding while optimizing revenue and maintaining compliance through varied venues and tasks (auditing, education and training).
• Serves as the Carle point person for questions regarding coding.
• Attends meetings regarding this area as needed.
• Maintains internal controls and management reports to monitor accounts receivables, productivity and quality.
• Maintains AR days under 5.
• Reviews and follows up on all PRO/Insurance review correspondence related to medical record documentation and coding.
• Reviews all DRG changes/denials and prepares letters of correspondence/appeal when needed.
• Works with RAC coordinator on all government audits and reviews.
• Provides input and follow up as needed for any payer specific coding audits and reviews.
• Maintains active involvement in all regulatory compliance functions by maintaining up to date working knowledge of latest healthcare trends in coding, reimbursement and clinical care management.
• Works with the EMR team to ensure record compliance with State and Federal Laws.
• Responsible for preparing and managing budgets for all coding area