Director, Inpatient Coding and Compliance

Scope of Position The Director of Coding, Compliance and Clinical Documentation Enhancement is responsible for assuring high quality information collection and reporting systems for medical information management services, including coding, data quality management, and compliance. The information collected and used by medical information management staff is interconnected with the clinical and business systems of the health system and is used for patient care, teaching, research, hospital operations, quality assurance, and reimbursement. Accurate coding and compliance is essential for a financially viable health care organization. The Director is responsible for managing department staff, programs, policies and activities related to coding services, data quality management, clinical documentation enhancement and Medical Information Management compliance for the health system. Specific areas include University Hospital (including the Ross Heart Hospital, Dodd Hall, ambulatory care provided in McCampbell Hall, Morehouse Medical Plaza and the Eye and Ear Institute), The James (inpatient, OBS, SDS), OSU Harding, and University Hospital East. Assists in planning, organizing and controlling medical record coding services, coding quality and billing accuracy (as related to coding services), and compliance to meet the patient care, teaching, research and administrative needs of The Ohio State University Wexner Medical Center. Effective management of coding and documentation enhancement staff resources is required to support accurate, timely and complete coding information required in the billing cycle. The Director analyzes performance to assess quality of coding and medical record documentation and prepares recommendations for action based on the results. Monitors effectiveness of data quality program and recommends improvements as necessary. Works with Administrative Director, Coding Data Analyst and Assistant Director of Documentation Improvement to monitor the various business units Case Mix Index (CMI) to identify opportunities for improvement in coding. Responds to reports from Coding Data Analyst that identify potential coding errors or inconsistencies. The Director oversees the departments compliance plan. This includes assuring the plan addresses all aspects of medical information management compliance, including assessment, training, policies and procedures, monitoring and corrective action. In the absence of the Administrative Director, the Director provides direction, supervision, and support to all Medical Information Management areas and staff. Advises administration, medical and managerial staff regarding specific issues and problems. Provides assistance as needed. Resolves intra-departmental and inter-departmental problems related to coding, documentation and compliance. Position Summary This position provides administrative direction to the coding services program and clinical documentation enhancement in Medical Information Management. Manages the program for high quality, timely coding of diagnoses and procedures for inpatient and outpatient accounts, using ICD-9-CM, ICD-10-CM/PCS and CPT-4 coding classification systems, to meet the hospitals billing system requirements. Manages the abstracting of data elements required for billing (admission type and source, discharge disposition, attending physician). Monitors the results of the program for quality improvement and timeliness. Manages ongoing review of coding for accuracy. Coding accuracy is critical to the Medical Centers Integrity Program and accurate reimbursement. This position provides administrative direction to the compliance program in Medical Information Management. The Director manages the compliance program, with emphasis on patient confidentiality and accurate coding and abstracting of data elements required for billing (admission type and source, discharge disposition, attending physician). This staff member assures compliance with CMS regulations regarding coding and data abstraction in order to reduce the organizations financial risk if non-compliant. The Director works with the Coding Data Analyst to benchmark the results of these programs against peer organizations for quality improvement and timeliness. Provides education on coding, compliance and documentation requirements. Directs the coding continuing education program for the departments coding, documentation enhancement and data quality management staff. Maintains department compliance plan and monitors performance against plan. Provides support for administrative and research needs of the organization by retrieving abstracted and other patient and or physician specific information from the abstracting system, data marts and information warehouse in response to requests from authorized requestors. The Director has strong organizational relationships with Case Management, Access and Revenue Management, Business Planning and the Information Warehouse; this staff member advises on issues related to coding and documentation as related to utilization management, financial performance, strategic planning, and administrative information needs. Position may assume departmental responsibility in absence of Administrative Director. Minimum Required Qualifications Bachelor's Degree in Health Information Administration or equivalent. Credentialed as a Registered Health Information Administrator by the American Health Information Management Association. 10 years of relevant experience required. 15 or more years of relevant experience preferred. #J-18808-Ljbffr