OP Coding Manager

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New Haven, CT
Dec 19, 2018


Job Description

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values-integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
Responsible for managing and directing the work activities of employees responsible for all Outpatient and Emergency Department Coding. Ensures accuracy and timeliness of diagnostic and procedure data entered into the Hospital billing system. Ensures coding meets regulatory compliance and coding guidelines. Works on revenue cycle objectives to improve documentation, charge capture and coding. Coordinates coding audits in Outpatient areas to identify coding and charge capture accuracy. Works with Reimbursement, Corporate Compliance, Clinics and ancillary departments on special projects.
  • 1. Direct activities of ambulatory and emergency room coding staff to ensure timely and accurate billing and data base integrity. Provides feedback routinely on performance standards.
  • 2. Initiates recruitment process when vacancies occur and participates in interview and selection of applicants for coding positions.
  • 3. Serves as a liaison to the System Billing Office for any coding related billing issues and processes claims held in outside billing scrubber.
  • 4. Analyzes charge data from various outpatient procedure-based areas and identifies and implements charge capture initiatives for increased revenue. Calculates net revenue gains and reports out to the CDMP committee.
  • 5. Implements published changes in ICD-9-CM, CPT-4, and HCPC's coding system, as well as changes mandated by State and Federal regulations; provides appropriate orientation and training to coding staff.
  • 6. Provides analysis on the impact of coding and reimbursement changes to the associate director, Coding and director of HIM.
  • 7. Participates with financial analysts and department managers in reviewing outpatient area Chargemaster.
  • 8. Oversees audits of all hospital based outpatient coding. Provides results to clinicians and clinical administration.
  • 9. Ensures that appropriate technical orientation and training relating to coding, APC assignment and data entry to newly hired coders through the Outpatient Specialist or Coordinator.
  • 10. Conducts programs for staff orientation and ensures compliance to Hospital personnel Policy/Procedures and related personnel functions.
  • 11. Ensures employees adhere to requirements for good patient/customer relations and evaluate performance accordingly.
  • 12. Works as a team with other HIM Management Staff to coordinate related systems/procedures to ensure uniformity.
  • 13. Promotes and fosters a positive customer relations environment in the work place, setting the example for staff members to interact successfully with co-workers.
  • 14. Provides input into HIM Departmental operating/capital budget preparation/monitoring process.
  • 15. Evaluates and coordinates supplies/equipment needs, ordering/arranging for ordering of supplies used within the unit.
  • 16. Ensures office equipment is maintained in good condition. Arranges for servicing of equipment when needed.
  • 17. Performs other related duties in the Department as required.
    Other information:


    Bachelor's Degree in Health Information Management or related field preferred. Certification as a CCS/CPC required.


    At least five (5) years progressive experience in a hospital outpatient coding environment with at least two years in a managerial role supervising outpatient specialty coding process and APC experience. Some coding, audit experience, either as a consultant or specialist, in outpatient environment helpful. Outpatient reimbursement and chargemaster experience required.


    Strong managerial skills and demonstrated high level of oral and written communication skills. In-depth understanding and knowledge of medical terminology and anatomy and physiology. Comprehensive knowledge of ICD-9-CM, CPT and HCPC's Coding; understanding of medical record systems and APC's. Understanding of current billing and regulatory requirements, (CCI Edits) including Federal Compliance Regulations. Excellent organizational and personnel management skills.

    Ensures that diagnostic and procedural data is entered into the hospital billing system on an accurate and timely basis. Monitors coding billing activities to ensure accuracy, as well as, regulatory and compliance requirements. Interacts with MIS technical and vendor support. Assures department charge masters are compliant with coding guidelines. Develops a variety of statistical reports to monitor and effectively report status, results and recommendations to senior level management.

    Position requires dealing with a variety of situations, exercising discretion and independent judgment in making decisions, managing employees and creatively solving issues. Determine appropriate diagnostic and procedure data from documentation in all types of medical records. Plans workload required to meet deadlines (including deadlines for billing) for submission of coded data. Monitors coding system performance and recommends enhancements to IS, Senior Management and Vendors as required. Must deal effectively with hospital staff, physicians and other clinical staff, needed to coordinate systems and procedures with multiple departments.

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    Job Info

    Job: 2969

    Department: HIM Coding
    Category: Mgmt/leadership
    Sub Category: NON-CLINICAL
    Hours: 40.00

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