Medical Records Coding Manager supervises and trains a team of medical coders to ensure medical records are coded with accuracy and completeness. Ensures medical records coding operations follow the latest guidelines and compliance standards. Being a Medical Records Coding Manager maintains required documentation and confidentiality of patient records. Implements processes for coding operations that support the needs of other healthcare partners. Additionally, Medical Records Coding Manager develops and maintains up-to-date knowledge of the latest ICD and CPT coding versions and ensures coders receive updates and training on classification or guideline changes. Is a certified medical coder and the exact type of coding certification may vary based on the clinical setting or a medical specialty focus. Typically requires a bachelor's degree in healthcare administration, a related field, or equivalent. Depending on the setting typically requires the Certified Coding Specialist (CCS) certification. May additionally have the Registered Health Information Administrator (RHIA) credential. Typically reports to a manager or head of a unit/department. The Medical Records Coding Manager supervises a group of primarily para-professional level staffs. May also be a level above a supervisor within high volume administrative/production environments. Makes day-to-day decisions within or for a group/small department. Has some authority for personnel actions. To be a Medical Records Coding Manager typically requires 3-5 years experience in the related area as an individual contributor. Thorough knowledge of functional area and department processes. (Copyright 2024 Salary.com)
Monitors coding quality and productivity levels according to established standards. Reviews coding queries for appropriateness. Coordinates and conducts coding quality reviews of targeted cases to assure timely billing and correct hospital reimbursement. Serves as a liaison between HIM, Velocity Healthcare and PFS to assure timely processing and claim accuracy. Performs random coding quality audits to validate coding accuracy. Reviews, tracks and maintains audit activity from Quality Improvement Organization (QIO) entities with a focus on Recovery Audit Contractors (RAC). Maintains the RAC reporting software. Completes and submits the AHA RAC Track report quarterly. Completes the Recovery Activity Report for the Corporate Compliance Committee. Coordinates with Health Information Management to obtain and review completed medical records to fill records requests from QIO/RAC entities within the required time frame. Analyze and respond to audit findings as necessary. Coordinates with the appropriate entities (internal and external) to insure that all audit responses/appeals are completed and filed in a timely manner. Assist with other Health Information management duties as assigned.
Completion of an approved program (Associates, Bachelors, Certificate,) in Coding or Health Information Management.
Three (3) years managerial experience in Coding, Health Information Management, or other revenue management related function. Five (5) years coding and abstracting experience in an acute care hospital setting or physician office setting.
Certified Coding Specialist (CCS) certified by AHIMA or (CPC) with CCS within one year of hire.
Knowledge of databases and computer applications required. Strong background in ICD-10-CM Classification Systems and Anatomy, Physiology, and Medical Terminology required. Strong knowledgebase and experience in coding and billing practices. Knowledge of regulations, standards, policies, and requirements pertaining to clinical documentation, coding and billing.
Detail oriented with strong managerial, leadership, and interpersonal skills. Demonstrated ability to organize multiple priorities. Demonstrate initiative and ability to work with other departments. Ability to understand the clinical content of a health record including the most complicated records. Ability to communicate with physicians to clarify diagnoses/procedures and sequencing of diagnoses. Strong quantitative and organization skills. Ability to communicate orally and in written form. Proficient in utilizing Microsoft Office. Proficiency in Intranet/Internet use. Knowledge of Meditech beneficial.