Associate Director, Outpatient Medical Coding-1

Scope of Position

The Senior Manager of Outpatient Coding Services performs at an expert level sustaining responsibility for timely and accurate coding of all facility outpatient visits and outpatient coding audits for The Ohio State University Wexner Medical Center (OSUWMC) including James Hospital. This position oversees the operations of denials, claim edits, and charge capture for reimbursement purposes. In this role, the Senior Manager of Outpatient Coding Services serves as a liaison and coordinator for special projects regarding the coding of medical records. This position develops and implements policies and procedures to achieve organizational goals; and assists in the development of operational strategy. This position also re-evaluates processes to keep staff engaged and to assist in meeting department and organizational goals for OSUWMC.

This position is critical to the financial and legal standing of the hospital for compliance and legal purposes. The manager shall assist in planning, organizing, staffing, and directing the outpatient coding area to ensure any outstanding accounts are properly coded and billed. The Outpatient Coding Manager is responsible for monitoring employee training, productivity, quality, and overall employee performance of all Outpatient Medical Record Coding Specialists, Failed Claims Specialists, Charge Capture Specialists, and MIM Student Interns.

This job role requires advanced clinical documentation review to educate providers, nurses, department leads/senior management, finance teams, and other stakeholders. The clinical documentation review the OP Coding Managers perform is critical to ensuring coding accuracy, compliance, and possible revenue optimization.

In addition, the Senior Manager of Outpatient Coding Services is responsible for allocating work assignments for claims that fail and conducts focused and random audits of medical

records for both coding as well as compliance Outpatient Code Editor (OCE), National Correct Coding Initiative (NCCI) and Medicare Code Editor (MCE) edits as requested by the central business office (CBO).

To achieve goals and financial metrics, the manager works in collaboration with various OSUWMC health system operational leaders, and the manager collaborates/networks with external vendors, external consultants, consulting team members and/or matrixed staff as required in support of hospital initiatives.

Position Summary

This role serves as the Senior manager for outpatient coding services, and compliance which includes, student interns, medical record coding specialists, and failed claims specialists. This team is vital to the continued operation of the entire Department as it serves to assign the codes necessary for the billing of the outpatient visit. Sets daily priorities, monitors accounts not coded, trains and supports coding specialists in assigning ICD-10-CM diagnoses, Hierarchical condition category (HCC) coding, operationalize SDOH, assign procedure codes (CPT-4), and determines APC assignments for billing and statistical purposes. The manager monitors performance to ensure compliance with policies and procedures and billing rules.

The manager sets forth daily priorities for staff, monitors accounts not resolved, and suggests innovative ideas to the Director of Coding and Compliance. The Senior Manager of Outpatient Coding keeps detailed records of all audits conducted, with results, reviews recommendations, and follows up with education to ensure correct action is taken. The manager develops training materials and conducts training sessions with the coding quality analysts, coders, and students. The manager works directly with the professional coding team leads, and other department managers, charge master analysts, medical staff, ancillary departments, the central business office, and all elements of the revenue cycle to improve coding and billing accuracy for the entire medical center.

Minimum Qualifications

For Hire:

Bachelors degree in health information administration or equivalent degree required.

Minimum 3 years of medical coding and/or revenue management experience required. Previous management experience preferred.

Seven years of relevant industry experience in health system-wide outpatient medical coding, and revenue cycle operations preferred.

Required certification can include Registered Health Information Record Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS) by the American Health Information Management Association, and the COC (outpatient credential only).

Considerable progressively responsible administrative medical information management experience required knowledge and experience with electronic health records and health information management applications required.

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