Department: CRI Quality & Performance

Reports to (title): Sr Director Coding Quality

JOB SUMMARY

The Director of Coding Quality is responsible for the daily management of coding quality auditing and review services for Client Business Center. This position ensures coding and auditing teams uphold Quality & Performance standards and Compliance policies and procedures. The Director also monitors and contributes to the maintenance of department budget and financial guidelines.

Essential Duties - 

1. Oversight for daily Coding Quality teams and client SLAs around quality monitoring and reporting. Ensure Conifer Compliance and Quality & Performance policies and procedures are maintained and effectively carried out. Escalates coding quality issues to SR Director of Quality and/or Compliance as required.
2. Continually assesses and improves Auditor and Audit Team performance through daily interactions, analysis and implementation of sustainable performance improvement initiatives.
3. Works collaboratively with CRI Operational leaders to ensure the coding quality of all coders meet or exceeds quality standards, prepares necessary periodic reporting for leadership, clients and governing bodies; ensures compliance with approved coding guidance across coding and claims submission, and participates in annual risk assessments.
4. Provides input and maintains a standardized data quality management plan to ensure consistency of quality data for the organizations internal data needs.
5. Serves as a subject matter expert and resource for information and clarification on accurate and ethical coding and auditing processes and demonstrates a thorough knowledge of coding guidelines, governmental regulations, and third party billing requirements and is able to compare/contrast the guidelines/rules/regulations in order to discern which apply to the audit being performed. Interprets the often complex clinical content of a patient record including the most complicated medical diagnoses and surgical procedures.
   

Financial Responsibility - Manage department within the budget & financial guidelines specific to the area of responsibility

Supervisory responsibilities - If direct report positions are listed below, the following responsibilities will be performed in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

Direct Reports - Coding Quality Manager, Coding quality Supervisor, Coding Quality Auditor

Knowledge, Skills and Abilities

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Strong leadership and communication skills, problem solving abilities; good knowledge of coding and reimbursement systems
• Ability to build and maintain team cohesion, performance and talent retention
• Serve as a resource to company and client contacts
• Advanced knowledge of ICD-10-CM/PCS CPT and HCPCS code sets, MS-DRG & APR-DRG classification and reimbursement structures, APC, OCE, NCCI, MUE classification.
• Advanced knowledge of disease pathophysiology, drug utilization and therapies
• Knowledge of and revenue cycle structures of hospitals, physician offices, medical clinics, and third-party payors

• Keeps abreast of new technology in coding and abstracting software and other forms of automation and stays informed about transaction code sets, HIPAA requirements and other future issues impacting the coding function
• Moderate to advanced skills in MS Excel and Powerpoint
• Ability to work under deadlines and juggle multiple projects
• Ability to work independently and as part of a team
• Ability to multitask with flexibility of daily priorities

Education / Experience

Include minimum education, technical training, and/or experience preferred to perform the job.

• Ten (10) years of recent experience in relevant coding management and leadership in the field
• Three (3) years of relevant management experience related to coding quality and auditing functions.
• Documented coding and auditing experience.
• Experience ICD-10-CM/PCS, CPT, HCPCS classification systems, and collaboration with CDI functions
• Bachelor/Associate degree in Health Information Management /Technology and AHIMA credentials preferred

CERTIFICATES, LICENSES, REGISTRATIONS

• Required: Current RHIA or RHIT AND CCS credential
• AHIMA ICD-10-CM/PCS Trainer preferred