Network Director of Coding

Valhalla, New York, Job Summary: The Network Director of Coding provides oversight and direction for the activities of the Coding Section of the Health Information Management Department (HIM) at Westchester Health Network, ensuring coding compliance and training of coding and healthcare staff network-wide. An individual in this position serves as subject matter expert for coding services and serves as HIM liaison to Outpatient departments, Patient Accounts, Patient Access, Chargemaster staff, Clinical Documentation Improvement Team, and all other appropriate teams regarding coding and documentation issues. Responsibilities: Directs and manages coding activities to ensure an efficient and effective process for coding, abstracting, and data reporting of inpatient, outpatient, emergency and ancillary services. Develops and ensures coding processes and guidelines that meet state, federal and hospital requirements and standards and works with medical staff to improve clinical documentation and facilitate accurate coding. Provides leadership and expertise in ICD-10 and CPT4 coding systems, as well as DRG and APC payment systems. Develops and manages processes for collection of data for coding that create consistency and efficiency in the coding of inpatient and outpatient claims to optimize DRG and APC reimbursement and facilitate data quality in coding services. Establishes systems to continuously monitor, review and validate the accuracy of all coded and abstracted data. Monitors and oversees responses to outside coding review agencies regarding denial notices and coordinates appeals. Performs extensive record review and brings identified concerns to department managers, medical staff, HIM professionals, and Chargemaster staff, as appropriate. Develops and maintains an internal coding quality control program to ensure the integrity of the coded data and accuracy, consistency and completeness of the coding.

Develops and maintains policies, procedures, and training materials for coding activities. Directs the training of new employees and ensures ongoing training of all staff. Monitors for violations of Standards of Ethical Coding and reports concerns to Health Information Management leadership when appropriate. Assumes a leadership role education and training of coding personnel. Accesses protected health information (PHI) in accordance with hospital policy. May perform other incidental tasks, as needed. Qualifications/Requirements: Experience: Seven years of experience in an acute care facility which included coding complex medical records and evaluating denial notices, two of which must have been at a supervisory or managerial level, required. Education: Bachelor’s Degree, required. Licenses / Certifications: Must possess and maintain current certification as a Registered Health Information Administrator/Technician (RHIA/RHIT) or Certified Coding Specialist (CCS) through the American Health Information Management Association (AHIMA). Other: Thorough knowledge of current practices and principles in the field of medical records coding; through knowledge of federal, state and payer specific regulations and policies pertaining to documentation, coding, privacy, and billing Thorough knowledge of ICD9/ICD-10, CPT4 coding, APC/DRG and CMS compliance requirements and ability to develop processes and procedures to support those requirements Thorough knowledge of local, state and federal regulatory requirements related to coding Ability to communicate concepts to cross functional departments or teams Ability to effectively collaborate with medical staff and other hospital departments Ability to manage complex projects and resources Ability to solve problems, identify solutions, strategize, plan and implement change Be able to effectively use coding software, including groupers, compliance tools, editors, optimizers and encoders Needs to interpret and analyze coding data, records, reports and performance measures Be able to communicate clearly, both orally and in writing; good judgment; accuracy; initiative; tact; resourcefulness; physical condition commensurate with the demands of the position.

About Us: NorthEast Provider Solutions Inc.

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