As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
The Quality Manager is responsible for developing, implementing, and maintaining a data quality management (compliance) plan for coding and reimbursement, health records and documentation, and quality data while supporting the growth of the HIM and Coding Division. This position also manages and supports all compliance aspects of the on-site, remote, regional and/or traveling coding teams. Additionally, this position oversees the review and monitoring of staff DRG, APC, ICD-9-CM and/or cpt-4 code assignments for accuracy and assurance that coding guidelines are being followed. Assist in the development and implementation of educational activities related to coding audit and coding quality for the division.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Responsible for insuring client deliverables are met related to the quality/compliance standards per current contract terms. This may be accomplished by, but not limited to, the following:
Coordinating daily workflow of auditing team to insure timely auditing of staff and accounts
Distributing workload amongst auditors by allocating assignments according to client needs
Directing work priorities of direct reports and/or support staff (administrative assistant, coordinators, revenue cycle staff, supervisors, etc) to insure timely processing of unaudited records, claims and or project deadlines.
Responsible for auditing of records/accounts to insure accuracy of the code assignments (ICD-9-CM and/or CPT-4), discharge disposition assignments, MS-DRG assignments, POA assignments, APC assignments and/or modifier assignments. Evaluate individual coder accuracy through focused audits. Identify education needs to facilitate coding accuracy improvement.
Developing, implementing, and maintaining a standardized, organization-wide, quality data management (compliance) plan and program to ensure compliance with external regulatory and accreditation requirements, ensuring consistency of quality data for the organizationâ��s internal data needs, and identifying, investigating, and preventing violations
Developing, implementing, and maintaining standardized, organization-wide policies and procedures to monitor the success of the quality data management plan, review areas of risk, investigate identified issues, report data analyses, and take appropriate steps to correct violations.
Establishing, implementing, and maintaining a formalized review process for compliance, including a formal review (audit) process
Providing consulting services in the area of data quality management to individuals, special projects, and executive and clinical departments throughout the organization
Partnering with appropriate personnel; developing and implementing standardized, organization-wide coding guidelines and documentation requirements; and developing and implementing training and educational programs for physicians and coders
Optimizing receipt of high-quality data from parent and contract hospitals by active participation and leadership in quality monitoring and improvement efforts
Attend meetings within and outside the facility as needed or requested to, provide input and act as a coding information resource. Utilize internal Conifer and qualified external resources to clarify coding policies, guidelines and â��grey areasâ�� while adhering to individual client coding policies and communicate information to coding staff
Various administrative functions associated with the above duties include but are not limited to budget development and monitoring, performance evaluations, team meetings, expense report review, interviewing/hiring new applicants, action plan development, corrective action, scheduling, coordinating internal and external quality reviews, presentation and report writing for external auditing reviews.
Provides input regarding departmental budget specific to area of responsibility.
Directly impacts days not final billed (DNFB), overall A/R and monthly revenue collection.
This position carries out supervisory responsibilities in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
Direct Reports (titles) Auditor, Coding Consultants
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Computer training: HBOC Star; TruCode, 3M Coding & Reimbursement software; SoftMed Systems; MS OFFICE; Horizon Patient Folder; Groupwise; DVI Dictation System; External Transcription Agency Systems. Manager must have the technical skills required to learn and navigate a variety of software systems, trouble-shoot computer problems, install periodic updates to software programs and work efficiently in a virtual environment
Extensive knowledge of medical record documentation requirements mandated by Medical Staff Bylaws, Rules and Regulations
State and federal regulations regarding patient confidentiality
Excellent verbal/written communication and interpersonal skills
Thorough/detailed knowledge of ICD-9-CM and CPT coding systems
Current knowledge of ICD-10-CM/PCS coding system
Skilled in formulating and writing statistical reports
Skilled in performing quality assessment/analysis
Ability to apply common sense understanding to carry out instructions furnished in written, oral or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
Advanced personal computing skills including MS Outlook, MS Word, MS Excel, MS Power Point; various encoders and groupers.
Must have strong interpersonal, written and verbal communication skills and management experience
Ability to think/work independently, yet interconnect within the team.
Advanced problem-solving skills
Project management skills
Ability to analyze financial and performance data
Great attention to detail is crucial to this position
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience required to perform the job.
An associates or bachelorâ��s degree in health information management or related degree (management, healthcare administration, business) is required.
Credentials to include one or a combination of the following: RHIA, RHIT and/or CCS.
A minimum of five (5) years of progressively responsible experience in coding and audit operations. Three (3) years of previous relevant management experience related to coding/audit functions is required. Childrenâ��s facility, academic or Level I or II trauma centers experience a plus.
Ability to manage all aspects of a team of on-site, remote, regional and/or traveling coders.
Experienced with performing quality assurance evaluations to validate correct coding
Must possess extensive knowledge of hospital inpatient and outpatient reimbursement methodologies.
Minimum five (5) yearsâ�� experience coding with ICD-9-CM and CPT-4 in an acute care environment.
Experience with various hospital information systems, encoders and other technology preferred
Current AHIMA approved ICD-10-CM/PCS trainer preferred
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Must be able to work in sitting position, use computer and answer telephone
Ability to travel
Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments
Duties may require bending, twisting and lifting of materials up to 25 lbs.
Duties may require driving an automobile to off- site locations.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Office Work Environment
Hospital Work Environment
Capacity to work independently in a virtual office setting or at hospital setting if required to travel for assignment.
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Internal Number: 2105023323
About Conifer Health Solutions
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.