Job Description
The Director of Health Information Management (HIM), Coding, and Clinical Documentation Improvement (CDI) will lead and oversee the efficient management of health information systems, coding practices, and clinical documentation efforts. The Director will be responsible for ensuring the accuracy, integrity, and compliance of clinical data, driving initiatives to improve documentation and coding operations, quality and compliance activities. This role will collaborate across departments to enhance data quality, optimize reimbursement, and ensure compliance with CMS conditions of participation for the medical record and the Joint Commission Record of Care. Minimum Education
Bachelor's Degree or equivalent experience in related field. (Required)
Master's Degree MBA or MHA (Preferred)
Minimum Work Experience 7 years Related and progressive experience including professional and technical coding, information privacy, Health Information Management, and clinical documentation integrity (Required)
6 years Progressively responsible supervisory/management experience (Required)
Required Skills/Knowledge Demonstrate effective managerial and administrative leadership of coding operations, health information, and collaborative working with Clinical Documentation Integrity programs.
Interprets impact of broad scope organizational change for staff and develops change strategies for successful implementation.
Develops and manages operational initiatives with measurable outcomes.
Broad understanding of all areas of the revenue cycle; including but not limited to patient financial services, health information management (HIM), revenue integrity (RI), and reimbursement services.
Experience in financial and programmatic presentations.
Responsible for a diverse, growing department requiring skills in data-driven decision-making, project and portfolio management, system redesign, process improvement/lean management, and customer relationship management.
Required Licenses and Certifications Registered Health Information Administrator (RHIA) (Required)
Certified Coding Associate (CCA) CCS or CCA (Required)
Certified Clinical Documentation Specialist (CCDS) (Preferred)
Functional Accountabilities Resource Manager - Directs and provides guidance to managers to effectively allocate resources based on patient volume, space availability, budget constraints, and program priorities, goals, and objectives.
- Monitors and analyzes financial data and utilizes decisions regarding FTEs, staffing, and operational budget.
- Provide regular reports on coding accuracy, CDI performance, and audit results to leadership and key stakeholders.
- Identifies lack of competency in performance and establishes a plan which includes goals, interventions, and measures.
- Maintains membership in professional organization(s) to develop knowledge and resources through networking, continuing education, and participation in national, regional, and/or local activities.
- Systematically measure vendor performance and meet with them regularly to ensure vendors have appropriate processes in place to maximize net revenue, health information processing, and coding accuracy.
CDI Management - Collaborate with clinical stakeholders to develop an organization-level roadmap of process and technology improvements to reduce provider burden and maximize patient experience while increasing efficiency.
- Educate clinical teams on the importance of accurate documentation in improving patient care, hospital reimbursement, and regulatory compliance.
- Oversee and perform regular reviews of clinical documentation to ensure accuracy, completeness, and compliance with coding and billing regulations.
- Monitor and analyze CDI metrics, including physician query rates, documentation accuracy, and the impact on reimbursement.
Coding Management - Directly responsible for oversight and successful operations of revenue cycle function by ensuring accuracy and timeliness inpatient and outpatient facility and all professional coding operations.
- Direct and ensure appropriate MS-DRG, APR-DRG, APC, and ICD-10 and CPT code, and modifier assignment for services provided to maintain an accurate reflection of services provided (e.g., case mix, severity of illness, mortality assessment, and hierarchical condition categories).
- Monitor work queues and reports for outstanding and/or uncoded encounters to reduce accounts receivable and pre-A/R days.
- In partnership with appropriate stakeholders, develop and implement standardized, organization-wide coding guidelines and documentation requirements and develop and implement training and educational programs for physicians and coders.
- Direct quality initiatives and compliance activities related to coding.
- Develop and implement corrective action plans for any deficiencies or areas of non-compliance discovered during audits.
Health Information Management - Ensure compliance with all relevant healthcare regulations, including HIPAA, HITECH, CMS guidelines, and industry standards.
- Collaborate with IT teams to optimize electronic health record (EHR) systems and data security.
- Participate in the development of health information management policies and procedures related, but not limited to, release of information, confidentiality, information security, information storage and retrieval, and record retention.
- Review claim denials and rejections pertaining to coding and medical necessity issues and, when necessary, implement process, such as educational programs, or revamp current processes to prevent similar denials and rejections from recurring.
- Work collaboratively with Medical Staff to comply with standards and guidelines through the Medical Staff Bylaws/Rules and Regulations (e.g., suspension of privileges) and is responsible for facilitation and execution of physician notification processes regarding medical record documentation deficiency and delinquency.
- Develops and directs health information/medical record format and content standards to assure complete, accurate, timely and compliant health information.
Organizational Accountabilities Organizational Accountabilities (Staff)
Organizational Commitment/Identification Teamwork/Communication
Performance Improvement/Problem-solving
Cost Management/Financial Responsibility
Safety
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Job Tags
Full time, Work experience placement, Local area,