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ASSOCIATE DIRECTOR, MEDICAL CODING DUHS

Job Title: ASSOCIATE DIRECTOR, MEDICAL CODING DUHS
Job Code: 5487
FLSA: E
Job Level: I2
Revised Date: 10/01/2016
Supervisory Responsibility: Yes

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General Description of the Job Class

The Associate Director will assist the Director by being directly responsible for HIM Coding. The Associate Director is responsible for managing, coordinating and performing day-to-day HIM Coding operations for the DUHS facilities. The Associate Director will implement and support the Director on all Corporate HIM Coding initiatives and activities; provide support at the facility level for daily department operations, reimbursement opportunities, various program and implementation, and HIM Coding -specific system installations. Responsibilities include interviewing, hiring and training employees; planning, assigning and directing workflow, appraising employee performance; addressing complaints and resolving problems; and proactively managing production and quality control efforts.

Duties and Responsibilities of this Level

Directs the planning, organizing, and coordinating all administrative and operational activities of Coding Unit:

- Develops long range and short term goals, objectives, plans, programs and assures the implementation of these.

- Assists Director in planning, developing, and controlling budgets including personnel, capital equipment and operations for the coding unit.

- Evaluates impact of innovations and changes in program, policies and procedures for Coding.

- Designs and implements systems and methods to improve accessibility of data. Identifies, assesses and resolves problems.

- Prepares administrative reports as requested

- Monitors unbilled account reports for outstanding services or uncoded discharges to reduce accounts receivable days for inpatients and/or outpatients; performs periodic claim form reviews to check code transfer accuracy from the abstracting software and the charge master; may serve on a charge master maintenance committee.

Oversees daily operations of Coding including work load and staffing; hiring, disciplining, and performance appraisals at DUH; and monitors quality and training of all coding employees at DUH, DRH, DHRH.

Serves as an expert resource for DUHS in prospective payment systems, such as DRGs and APCs.

Oversees and monitors the compliance program for Coding at DUHS:

- Conducts and oversees coding review efforts and coordinates monitoring of coding accuracy and documentation adequacy.

Continuously evaluates the quality of clinical documentation to identify incomplete or inconsistent document for inpatient and/or outpatient encounters that impact the code selection and resulting APC/DRG groups and payment; brings concerns to the attention of the HIM Director and/or medical staff for resolution.

Provides or arranges for training of facility health care professionals in the use of technical coding guidelines and practices, proper documentation techniques, medical terminology and disease as they relate to the DRG, APC and other data quality management.

- Oversees the development of coding policies, coding guidelines.

- Maintains coding compliance manual for DUH, DRH, DHRH.

- Provides feedback and focused educational programs on the results of auditing and monitoring activities to affected HIM Directors, coding staff and physicians.

- Conducts trend analyses to identify patterns and variations in coding practices, case-mix-index, patient safety indicator, and other factors influence overall ranking for DUHS.

- Compares coding and reimbursement profile with national and regional norms to identify variations requiring further investigation.

- Reviews claim denials and rejections pertaining to coding and medical necessity issues and, when necessary, implements corrective action plan, such as educational programs, to prevent similar denials and rejections from recurring.

- Reports noncompliance issues detected through auditing and monitoring, nature of corrective action plans, and results of follow-up audits to the directors of HIM and the compliance officer.

- Receives and investigates reports of coding compliance violations and communicates this information to the compliance officer.

- Ensures the appropriate dissemination and communication of all regulation, policy, and guideline changes.

- Interacts with a wide variety of people who strongly impact the success of coding compliance program and functions as a facilitator, liaison, and/or motivator.

Develops, implements and monitors procedures for the APCs outpatient reimbursement system ensuring optimal reimbursement. Presents and provides reports on APCs to HIM Directors and hospital administration.

Required Qualifications at this Level

Education

BS Health Information Management, Health Informatics, Medical Record Science, Medical Record Administration, or related field. Masters degree in Business Administration or Health Administration is preferred.

Experience

Eight (8) years of progressive management and/or consulting experience in a healthcare environment is required, of which four (4) years management experience in an acute care teaching hospital HIM department and four (4) years of hospital (in-patient and out- patient) experience required.

Degrees, Licensure, and/or Certification

Registered Health Information Technician (RHIT) or Administrator (RHIA) certification. CCS preferred.

Knowledge, Skills, and Abilities

Extensive knowledge of ICD-9-CM and CPT coding principles and guidelines

Extensive knowledge of hospital/technical and professional services reimbursement systems (DRGs, APCs, RBRVUs)

Extensive knowledge of federal, state, and payer specific regulations and policies pertaining to documentation, coding, and billing for professional and technical services

Strong managerial, leadership, and interpersonal skills

Excellent written and oral communication skills

Excellent analytical skills

Distinguishing Characteristics of this Level

N/A


The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in this description.


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Essential Physical Job Functions

Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.