Yale New Haven Health System

Overview

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

Responsible for managing the activities and the employees of the Outpatient Coding Unit within the Coding and Documentation Improvement Department. Reporting to the Senior Manager of Outpatient Coding, the Manager is responsible for maintaining the data quality management plan that provides for quality coding from a clinical documentation, productivity, compliance, and accuracy perspective. The Outpatient Coding Manager creates a support structure within Coding for achieving clinical and operational excellence in relation to OP coding and documentation processes. The Manager possesses a strong level of OP clinical coding expertise, a solid foundation of government coding and billing regulations, and superior leadership skills to manage and provide oversight to credentialed coders. The position requires strong ICD-10, CPT, and PCS coding skills to ensure accurate and complete data capture for Outpatient Cases. Successful outcomes are reliant upon building effective working relationships with partner departments, clinical staff, finance and revenue cycle to improve quality and completeness of documentation of care provided which supports correct coding, performance metrics and appropriate charge capture. The Manager also coordinates coding audits and reviews for the Outpatient Coding Department to identify coding and charge capture accuracy.

EEO/AA/Disability/Veteran

Responsibilities

• 1. Direct day-to-day activities of OP coding work and coding staff to ensure completeness along with timely and accurate coding. This includes, but is not limited to: maintaining department goals in the DNFB, ensuring coders meet and/or exceed the department accuracy and productivity metrics, identifies trends in edits and proposes changes to improve timely billing, etc. Ensures that all OP coding and query practices are compliant with regulatory requirements.
• 2. Through recruitment, development, training/education and mentoring, develops a collaborative team of highly skilled coding professionals with clinical, coding, reimbursement, and quality skills possessing one or more coding certifications. Develops, or works to implement plans for extensive formal and informal coder education to cross train, and ensure department accuracy and efficiency. Mentor supervisory team members to create a strong and efficient leadership team. Initiates the recruitment process when vacancies occur and is an active participant in interviewing and selecting applicants for OP coding. Conducts programs for staff orientation, new employee development, and ensures compliance to Hospital personnel Policy/Procedures and related personnel functions.
• 3. Responsible to ensure audit and monitoring of OP coding for accuracy, including and not limited to coder work product, simple visit coding, etc.
• 4. Analyzes coding and charge data and implements charge capture initiatives based on analysis in order to appropriately increase revenue. Calculates net revenue gains and reports findings to senior leadership.
• 5. Serves as a liaison to partner departments at the management level, including the SBO, for any coding related billing issues.
• 6. Identifies updates in ICD 10, CPT, and HCPC's, as well as changes mandated by State and Federal regulations and works to determine impact to the department. Ensures appropriate orientation and training to coding staff is provided, as needed. Provides analysis on the impact of documentation, coding and reimbursement changes to Coding leadership.
• 7. Works internally and with staff to ensure the appropriate use, and utilization of the 3M 360 encoder.
• 8. Practices, adheres, and enforces the AHIMA code of Conduct philosophy. Promotes, fosters and role models a positive working environment using YNHH Standards of Professional Behavior.
• 9. Performs other related duties in the Department as required.

Qualifications

EDUCATION

Bachelor's Degree required. RHIA preferred. Certification as a CCS/CPC required.

EXPERIENCE

At least five (5) years progressive experience in a hospital outpatient coding environment or coding compliance with at least two years in a managerial capacity. Audit experience in the outpatient environment helpful. Knowledge of outpatient reimbursement, and charge master experience required.

LICENSURE

RHIA or RHIT preferred. CCS/CPC required.

SPECIAL SKILLS

Demonstrated ability to provide leadership and direction to employees in a complex healthcare environment. Candidate requires strong coding with extensive knowledge in ICD-10, CPT, and HCPC coding conventions. In-depth understanding and knowledge of medical terminology and anatomy and physiology. Requires knowledge consistent with an OP auditor/educator, which includes familiarity with auditing/monitoring techniques and educational platforms for coders. Knowledge of payer policy trends and revenue cycle management concepts. Understanding of current billing and regulatory requirements, (CCI Edits) including Federal Compliance Regulations. Works independently with minimal supervision. Excellent organizational, personnel management, and interpersonal skills. Strong managerial skills and demonstrated high level of oral and written communication skills.

YNHHS Requisition ID

146515