The Manager Data Quality, under general supervision of the Senior Manager Coding, has direct oversight for the inpatient coding auditors and ensuring integrity of coded data. Responsible for reviewing medical records and coding diseases and operations in accordance with the requirements of the ICD-10-CM coding conventions and the requirements of Medicare Prospective Payment System. Reviews documentation for AHRQ quality measures, billing activities and for retrieval of medical and statistical information for research and management purposes. Adheres to the AdventHealth policies and procedures while ensuring the adherence to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies. Maintains the confidentiality of employees, patients, administrative staff and functions, and medical staff information with no infractions. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
What You Will Need:
EDUCATION AND EXPERIENCE REQUIRED:
• Five years of inpatient coding experience in an acute-care hospital setting
LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:
• RHIA, RHIT or CCS certification or credential
KNOWLEDGE AND SKILLS REQUIRED:
• Leadership skills
• Excellent Communication skills
• Critical thinking and problem solving skills
• Ability to educate effectively
• Thorough knowledge of medical terminology, anatomy & physiology and pathophysiology
• Broad knowledge of inpatient coding, Medicare DRG’s, coding guidelines and reimbursement systems including MS office and Encoder software
Supervise report(s) who assist in the execution of the duties related to H.I.M processes and/or services.
EDUCATION AND EXPERIENCE
Progressive professional growth
Previous coding management experience
KNOWLEDGE AND SKILLS :
• 3M Coding Software
• General understanding of AHRQ Patient Safety and Quality Improvement
Manages, develops and coaches inpatient coding auditors, motivating and supporting others in overcoming barriers to understanding.
Reviews medical record documentation and coded data for AHRQ quality indicators, ensuring accurate quality measurement and reporting.
Collaborates with CDI to review variances and establish criteria/guidelines for improved documentation consistent with clinical definitions and compliant with coding regulations.
Serves as a subject matter expert on the interpretation and application of coding rules and regulations. Researches, abstracts and educates various stakeholders on federal, state and payer documentation and coding rules and regulations.
Conducts periodic assessment of AdventHealth Orlando inpatient coding quality program, providing suggestions for improvement based on regulatory compliance and organizational needs.
Assists senior management with external and post payment audits, helping to develop and create compelling responses to DRG discrepancies by providing information from the clinical record and referencing coding rules and guidelines.
Uses critical thinking and sound judgement in decision making keeping reimbursement considerations in balance with regulatory compliance.
Assumes personal responsibility for professional growth, development and continuing education to maintain a high level of proficiency.
At AdventHealth, Extending the Healing Ministry of Christ is our mission. It calls us to be His hands and feet in helping people feel whole. Our story is one of hope — one that strives to heal and restore the body, mind and spirit. Our more than 80,000 skilled and compassionate caregivers in hospitals, physician practices, outpatient clinics, urgent care centers, skilled nursing facilities, home health agencies and hospice centers are committed to providing individualized, wholistic care.