System Manager Hospital Coding

JOB DESCRIPTION:

In partnership with HIM and Revenue Cycle leadership, the System Hospital Coding Manager is responsible for the development, implementation, training and monitoring of UVM Health’s hospital coding policies and procedures.  This role provides administrative oversight relating to coding and coding compliance of the hospital medical record and serves as the Health System’s resident expert for hospital coding.  Develops and monitors hospital inpatient and outpatient coding processes and EMR workflows and ensures benchmarks for productivity and quality are being met. Additional responsibilities include preparation and supervision of external audits; leading coding supervisors on internal auditing processes and audit systems; communication with HIM and other UVMH staff to ensure compliant coding and billing practices. Facilitates development, monitors and ensures timely and accurate completion of all coding edits, hold bills, correct coding initiative edits, claims scrubber edits and internal coding edits and other required data reporting. Acts as a content expert to ensure regulatory or operational coding issues impacting correct billing is communicated to IS analysts, Revenue Cycle, Revenue Integrity, Compliance and/or other relevant system department leaders as needed to support compliant coding and data quality.

Actively researches and stays abreast of current and proposed regulatory information and coding guidelines and documentation issues. Is knowledgeable of ICD-10 and related implementation requirements and helps prepare the organization and staff for annual updates to Correct Coding Guidelines. Educates and disseminates information as appropriate to HIM coding supervisors, Revenue Cycle, Compliance, Medical Group Management, Utilization Review and all other UVMH departments.  Partners with System Director UR/CDI regarding the UMVH Clinical Documentation Improvement program.  Reviews the quality of the coding functions and identifies process improvement needs. The System Hospital Coding Manager constantly monitors and evaluates policies and procedures to ensure they follow all regulatory guidelines. Serves on various committees to support UVMH Revenue Cycle and Compliance processes.

EDUCATION:

• Bachelor’s degree in HIM or related discipline.  Five years of Coding leadership experience in a multi-facility health system may be substituted for the education requirement.

• One of the following active credentials required: CCS or CPC

• Strong understanding of clinical terminology, anatomy/physiology, pharmacology basics, and medical record documentation standards.

• Demonstrated knowledge of ICD-10-CM, CPT, HCPCS Level II, modifiers, and official coding guidelines.

• Working knowledge of payer policies (e.g., Medicare, Medicaid, commercial), medical necessity concepts, and denial prevention.

• Familiarity with provider-based billing rules, rural health clinic (RHC) or federally qualified health center (FQHC) workflows, preferred

EXPERIENCE:

Minimum of 5 years of progressive healthcare coding leadership experience in the hospital setting; CAH/rural health experience preferred. Prior work as a hospital coder is required.