The Health Information Management Coding Supervisor is responsible for supervising and training the work of staff who review, interpret, code, and abstract medical records information according to standard classification systems; performs data quality reviews; prepares coding reports, and performs other related duties as assigned.
The Health Information Management Coding Supervisor reports directly to the Director Health Information Management.
Supervises and performs a wide range of activities pertaining to the review and coding of inpatient and outpatient medical record information.
Establishes, implements, and maintains a formalized review process for coding compliance, including a formal review (audit) process; designs and uses audit tools to monitor the accuracy of clinical coding.
Performs data quality reviews on inpatient records to validate ICD-10 and other codes; verifies Diagnosis Related Group (DRG) appropriateness; checks for missed secondary diagnoses and procedures and ensures compliance with all DRG mandates and reporting requirements; monitors Medicare and other DRG paid bulletins and manuals, and reviews the current Office of the Inspector General (OIG) work plans for DRG risk areas.
Performs data quality reviews on inpatient records to validate ICD-10, the Current Procedural Terminology (CPT), and the Healthcare Common Procedure Coding System (HCPCS) Level II and modifier assignments; verifies Ambulatory Payment Classification (APC) appropriateness; checks for missed secondary diagnoses and/or procedures; ensures compliance with all APC mandates and outpatient reporting requirements; monitors medical visit code selection against facility specific criteria for appropriateness; assists in the development of such criteria as needed.
Monitors inpatient case mix reports and the top DRG’s to identify patterns, trends, and variations. Investigates and evaluates potential causes for changes or problems, and explains variances.
Monitors outpatient service mix reports to identify patterns, trends, and variations, and evaluates potential causes for changes or problems, and explains variances.
Monitors unbilled account reports to reduce accounts receivable days for inpatient/outpatient accounts. Performs periodic claim form reviews to check code transfer accuracy form the abstracting software.
Monitors and evaluates coders work and initiates disciplinary action as needed in conjunction with the HIM Director. Assists with and promotes the recruitment and retention of qualified staff as needed.
Continuously evaluates the quality of clinical documentation to identify incomplete or inconsistent documentation that impacts code selection, bringing concerns to the attention of the HIM Director.
Provides training of facility healthcare professionals in the use of technical coding guidelines and practices, proper documentation techniques, medical terminology and disease as they relate to the DRG, APC, and other data quality management.
Maintains competency in the use of computer applications currently in use by Health Information Management.
Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association, and maintains current certifications as appropriate.