Program Mgr-Coding and Documentation Quality

OverviewProgram Manager, Coding and Document Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is East Tennessee’s top-performing healthcare network with 10 hospitals (http://www.covenanthealth.com/hospitals/) and over 85 outpatient and specialty services (http://www.covenanthealth.com/services/) , and Covenant Medical Group (http://www.covenantmedicalgroup.org/) , our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned, not-for-profit healthcare system and the area’s largest employer with over 11,000 employees. Covenant Health is the only healthcare system in East Tennessee to be named six times by Forbes as a Best Employer. Position Summary: Develops and manages the Coding and Documentation Quality Program. Is accountable for concurrent review of health records to track documentation supporting the severity of the patient’s condition and the resources used in the diagnosis and treatment of the patient in order to assure appropriate DRG assignment and the validity and reliability of the case-mix index. Develops educational resources necessary to assure compliance with federal, state and private rules and regulations on data collection, coding and reimbursement. Responsibilities

Develops and manages the Coding and Documentation Quality Program, including the daily supervision and leadership of the coding function within the hospital’s Health Information Management Department.

Conducts concurrent record review of documentation to support the severity of the patient’s condition, resources used in the diagnosis and treatment and proactive DRG management in a multidisciplinary team approach to assure the validity and reliability of the case-mix index.

Audits medical record coding to ensure compliance with ICD-9-CM coding guidelines and principles to ensure optimal code assignment for research purposes, financial reimbursement, planning, statistics and regulatory reporting.

Coordinates and performs quality review of coding, abstracting, and DRG assignment in order to identify and monitor patterns of variations in the case mix index.

Develops action plans to improve issues identified during auditing and monitoring.

Participates as an integral team member for the management of care for patients.

Provides education and training to the care providers in areas relevant to documentation, DRG’s and coding.

Develops and provides training for physicians and other clinicians on documentation and coding issues. Serves as an internal consultant (resource) for case managers, staff, physicians and administration on accurate and ethical coding, documentation, and DRG issues. Collaborates and partners with financial teams and clinical services to improve documentation trends that are identified by auditors as deficient.

Performs focused reviews of documentation in ancillary services and suggests improvement opportunities or develops educational tools when necessary.

Works with Covenant Health Systems Compliance Officer and other healthcare facilities on compliance issues and performance improvement issues related to coding and compliance.

Researches and monitors professional journals and web-sites (CMS, AHIMA, and Federal Register) for new developments and trends to ensure organizational adaptation and compliance.

Maintains knowledge of federal, state, and private regulations for coding, reimbursement, and data collection requirements by third parties. Maintains a relationship with Knoxville Area Health Information Management Association (KAHIMA), Tennessee Health Information Management Association (THIMA) and the American Health Information Management Association (AHIMA) in order to network with Health Information Management Professionals on issues related to coding and documentation issues. Maintains membership in various AHIMA Communities of Practice to monitor current issues in coding and compliance. Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested. Performs other duties as assigned.

QualificationsMinimum Education: None specified; however, must be sufficient to meet the standards for achievement of the below indicated license and/or certification as required by the issuing authority.

Minimum Experience: Five (5) years of hospital inpatient coding experience. Extensive knowledge of ICD-9-CM/CPT principles and guidelines; Extensive knowledge of reimbursement systems (DRG’s and APR-DRG’s); Extensive knowledge of federal, and state regulations and policies pertaining to documentation, coding and billing; Strong managerial, leadership and interpersonal skills; Excellent written skills, oral communication and presentation skills; Knowledge of 3M Encoder; Proficiency in Microsoft Office Software ApplicationsLicensure Requirement: Must have and maintain a Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT). Certified Coding Specialist (CCS) must be obtained within the first year. Apply/ShareJob Title Program Mgr-Coding and Documentation Quality ID 3733874 Facility Covenant Health Corporate Department Name Clinical Doc Integty