Johns Hopkins Health System
Johns Hopkins Health System employs more than 20,000 people annually. When joining the Johns Hopkins Health System, you became part of a diverse organization dedicated to its patients, their families, and the community we serve, as well as to our employees. Career opportunities are available in academic and community hospital settings, home care services, physician practices, international affiliate locations and in the health insurance industry. Great careers continually advance here.
The Manager of the Coding Quality Unit will report to the Director of Casemix Information Management. The Manager will organize audits at all facilities aimed at confirming compliance with the health system guidelines as well as with all coding guidelines and conventions. The Manager will work with documentation improvement teams at all hospitals to assure compliance with all guidelines as well as identify coding opportunities to pursue. The manager will assess staffing at all institutions, working with coding managers to assure all staff or auditors have been oriented prior to performing any coding or auditing function. The manager will coordinate all coding training and will assure consistent coding production processes, standards and computer systems across all organizations. The manager will recommend corrective action where standards are not being met and will assist individual department personnel in identifying and implementing solutions and evaluating individual performance through to resolution. Manager will develop training for new coders as well as approving and writing or rewriting all guidelines to be used for facility hospital billing for the Johns Hopkins Health System. The position also requires a high level of communication with clinical and administrative staff. This individual will serve as a liaison and reference person for the administrators, physicians, and clinical systems support personnel. Manager will be intimately involved in the EPIC implementation process.
- Oversees and monitors implementation of the HIM compliance program
- Manages and audits retrospective query process per guidelines set forth in the AHIMA Query Practice Brief
- Serves as the primary Epic resource
- Develops and coordinates educational and training programs regarding elements of the HIM compliance program, such as appropriate documentation and accurate coding, to all appropriate personnel, including HIM coding staff and documentation improvement teams at all hospitals
- Ensures that coding and auditing consultants understand and agree to adhere to the organization’s HIM compliance program
- Conducts regular audits and coordinates ongoing monitoring of coding accuracy and documentation adequacy
- Provides feedback and focused educational in-services on the results of auditing and monitoring activities to all HIM coding departments and documentation improvement teams at all hospitals
- Compares coding and reimbursement profile with national and regional norms to identify variations requiring further investigation
- Conducts internal investigations of changes in coding practices or reports of other potential problems pertaining to coding and documentation
- Initiates corrective action to ensure resolution of problems areas identified during an internal investigation or auditing/monitoring activity
- Coordinates the appeals for errors due to coding under RAC audits
- Data mining in response to RAC findings, and risk analysis in preparation for permanent RAC reviews
- Reports noncompliance issues detected through auditing and monitoring, nature of corrective actions plans implemented in response to identified problems, and results of follow-up audits to the Director of Casemix Information Management
- Ensures the appropriate dissemination and communication of all regulation, policy, and guideline changes to affected personnel
- Serves as a resource for staff, documentation improvement teams, HIM coding department and administration to obtain information or clarification on accurate and ethical coding and documentation standards, guidelines, and regulatory requirements
- Monitors adherence to the HIM compliance program
- Revises the HIM compliance program in response to changing organizational needs or new or revised regulations, policies, and guidelines
- Requires excellent and comprehensive knowledge of anatomy, physiology, as defined by the Medical Diagnostic Categories and all body systems. Strong background knowledge of disease process, pharmacology.
- Requires college-level knowledge of Medical Terminology.
- Requires a complete and thorough understanding of the unique functions of each clinical area.
- Must be conversant in: ICD-10-CM, APRDRGs, DRGs
- Must be proficient with Microsoft Word, Excel, and Power Point. Knowledge of Access, knowledge of other programming languages a plus.
- Requires in-depth knowledge of clinical coding processing and documentation standards, guidelines, policies and procedures.
- Must be conversant in clinical documentation improvement.
- High level of proficiency in adult education and training
- Requires a thorough understanding of Hospital bylaws and Joint Commission standards related to departmental activities.
- Requires knowledge of clinical pertinence requirements and proficiency in abstraction and data entry into all of the data base systems used for clinical documentation.
- Must be able to read and interpret electronic and manual documentation generated by healthcare professionals.
- Requires understanding of HSCRC and CMI impact on hospital budget
Certified Coding Specialist (CCS) within 1 year; previous DRG validation is required.
Requires minimum three years coding management experience, three years previous validation experience and five plus years of inpatient and outpatient coding experience. Experience with the implementation of a Electronic Medical Record System highly preferred.
- Requires analytical ability to allow for interpretation of clinical data in all clinical specialties to determine appropriate diagnoses supported by clinically pertinent data, ICD-10-CM and CPT-4 coding.
- Requires excellent written, oral communication and interpersonal skills. Ability to effectively communicate with all Hospital practitioners is essential.
- Requires the ability to provide constructive feedback for the development of coding staff.
- Requires the ability to develop and conduct in-service training relative to coding for individual practitioners and groups of clinicians.
- Must demonstrate knowledge of and experience with documentation improvement techniques.
Bachelor’s degree with RHIT or RHIA required.
Masters degree preferred.
Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.
Johns Hopkins Health System and its affiliates are drug-free workplace employers.