Health Information Mgt Manager

Summary

The Health Information Management Manager plans budgets organizes and directs Health Information Management and Clinical Documentation Integrity services for the hospital and its provider clinics. The position is accountable for complete accurate and timely coding and documentation which drives clean claims appropriate reimbursement and a controlled unbilled (DNFB) balance. The manager also ensures the confidentiality integrity and availability of the legal health record and compliance with federal state accreditation and payer requirements.

Essential Duties and Responsibilities

1. Coding and Revenue Integrity

• Directs all coding operations: inpatient (MS-DRG and other payer-required DRG systems) outpatient emergency and observation (APC/OPPS) and provider clinic coding (CPT HCPCS E/M and HCC risk adjustment).
• Owns measurable unbilled targets and reports them weekly: DNFB dollars and days coding turnaround and aging of accounts held for coding.
• Maintains an escalation process for coding holds and documentation delays including missing diagnoses emergency physician notes discharge summaries and operative reports.
• Sets and enforces coding productivity and accuracy standards; conducts internal coding audits and coordinates external audits.
• Implements annual and quarterly code set updates (ICD-10-CM/PCS each October 1; CPT/HCPCS each January 1 and quarterly) with education and system updates.
• Partners with Revenue Cycle and Charge Description Master (CDM) to resolve coding-related claim edits (NCCI MUE scrubber and payer edits).
• Manage outsourced and remote coding vendors including contract terms performance targets and audit results.

2. Clinical Documentation Integrity (CDI)

• Leads the CDI program for inpatient services.
• Supports accurate risk adjustment (HCC) documentation for Medicare Advantage and other value-based populations.
• Ensures all physician queries are compliant with AHIMA/ACDIS query practice guidelines.
• Monitors and reports CDI performance: case mix index CC/MCC capture severity of illness and risk of mortality query volume response rate and agreement rate.
• Provides education for physicians advanced practice providers and clinical staff.

3. Denials Audits and Appeals

• Manages coding and clinical documentation denials including DRG downgrades medical necessity and coding edit denials; prepares or oversees appeals.
• Coordinates responses to external audits and record requests in conjunction with the RAC Auditor: RAC MAC/TPE UPIC OIG and Medicare Advantage and Medicaid managed care plan audits.
• Tracks denial root causes and reports trends and corrective actions monthly to revenue cycle leadership.

4. Physician Record Completion

• Manages record deficiency tracking by provider for the hospital and enforces Medical Staff Bylaws and Rules and Regulations for timely completion of discharge summaries operative reports emergency notes history and physicals and authentications.
• Maintains delinquent records at or below The Joint Commission threshold and reports delinquency to the Medical Executive Committee.

5. Provider Clinics

• Oversees documentation coding and health record standards for all system-owned provider clinics including E/M guideline education for providers.
• Standardizes scanning indexing release of information and record retention processes across all locations.
• Ensures documentation and billing support meet the requirements of each clinics designation.

6. Release of Information Privacy and Records Management

• Ensures patient right-of-access requests are fulfilled within HIPAA timelines and in compliance with 21st Century Cures Act information blocking rules including patient portal access.
• Manages subpoenas court orders legal holds amendment requests and accounting of disclosures; oversees release-of-information vendors.
• Partners with the the Compliance Officer on access audits breach investigations and privacy education.
• Maintains Master Patient Index (MPI) integrity including duplicate record identification merges and overlay correction.
• Maintains the legal health record definition designated record set and record retention and destruction schedules in accordance with Louisiana law and federal requirements.
• Oversees birth certificate and vital records processing.

7. Data and Technology

• Serves as HIM lead for EHR optimization encoder and computer-assisted coding tools document imaging and EHR downtime procedures.
• Evaluates emerging technologies including AI-assisted documentation and coding for accuracy compliance and return on investment.
• Produces a monthly HIM dashboard covering DNFB coding turnaround coding accuracy delinquent records release-of-information turnaround CDI metrics and coding-related denials.

8. Leadership Staffing and Financial Management

• Keeps hospital administration informed of departmental activities performance risks and needs.
• Develops implements and revises HIM and CDI policies and procedures and ensures compliance with The Joint Commission CMS Conditions of Participation Louisiana Department of Health and other regulatory requirements.
• Sets annual department goals aligned with the hospitals strategic plan and monitors progress.
• Staffs the department to productivity standards; recruits hires trains develops and evaluates staff.
• Prepares and manages the department operating budget including vendor and outsourced coding costs.
• Ensure staff maintain required credentials and continuing education and maintains own AHIMA credentials.

Standards of Behavior

Employee must be both committed to and accountable for demonstrating supportiveness etiquette respect vibrancy integrity communication and excellence in service delivery by adhering to the behaviors specified in the Service Standards of Behavior.

Minimum Qualifications

Physical Demands

The position is primarily office-based and sedentary with regular computer use.

Environment Requirements

Bloodborne pathogens chemical airborne communicable disease extreme temperature and noise exposure are not anticipated.

Employee Statement of Understanding

I have read and understand the job description for my position. I am able to perform all of the essential functions of this position.

The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position.

The job description does not constitute an employment agreement between the Hospital and the employee. The job description is subject to change as the needs of the Hospital and requirements of the job change.

Required Experience:

Manager