Manager - Coding And Clinical Documentation (Remote/Hybrid)

We've made a lot of progress since opening the doors in 1942, but one thing has never changed - our commitment to serve, heal, lead, educate, and innovate. We believe that every award earned, every record broken and every patient helped is because of the dedicated employees who fill our hallways.

At Ochsner, whether you work with patients every day or support those who do, you are making a difference and that matters. Come make a difference at Ochsner Health and discover your future today!

This position manages teams responsible for reviewing and coding electronic/paper based medical records, ensuring acute/chronic conditions are coded accurately and the encounter submission is substantiated in the member's medical chart per regulatory ICD-10, CPT, and HCPCS coding guidelines. Manages and performs quality assurance coding reviews of coders/coding vendors to ensure compliant and appropriate ICD-10 code selection associated with Risk Adjustment and HCC coding. Verifies the accuracy, completeness, and appropriateness of diagnosis codes based on the medical documentation provided by contracted facilities and providers. Ensures the team utilizes regulatory coding guidelines, recommends changes to diagnosis codes based on the chart review, and develops provider engagement materials/resources to improve clinical medical record documentation.

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 qualified individuals with disabilities to perform the essential duties.

This job description is a summary of the primary duties and responsibilities of the job and position. It is not intended to be a comprehensive or all-inclusive listing of duties and responsibilities. Contents are subject to change at the company's discretion.

Education

Required

• High School Diploma or equivalent

Preferred

• Bachelor's degree in Healthcare Administration, Business Administration, or related field

Work Experience

Required

• 5 years of Coding experience total, with 3 of those years in Medical Record Coding Auditing

ICD-10, CPT, HCPCS Coding guideline experience

Certifications

Required

• Must have at least one of the following coding certifications currently:

• Certified Professional Coder (CPC)

• Certified Coding Specialist (CCS)

• Certified Professional Coder-Hospital (CPC-H)

• Certified Coding Specialist, Professional (CCS-P)

• Registered Health Information Administrator (RHIA)

• Registered Health Information Technician (RHIT)

Knowledge Skills and Abilities (KSAs)

• Proficiency in using computers, software, and web-based applications.

• Effective verbal and written communication skills and ability to present information clearly and professionally.

• Strong interpersonal skills.

• Organizational skills.

• Communicate effectively with team, leadership, and internal departments as necessary to address issues and concerns.

• Advanced knowledge: medical terminology & abbreviations, anatomy & physiology, major disease processes & pharmacology, ICD-9-CM, ICD-10-CM, CPT & HCPCS coding guidelines, as well as regulatory requirements.

• Proficient in Microsoft Office Applications, coding, and compliance standards with strong ability to produce correspondence, charts, spreadsheets.

• Excellent interpersonal skills, as well as written communication skills.

• Orientation toward analytical problem solving with practical, result-oriented mindset; and the ability to research and resolve complex coding/documentation issues.

• Ability to manage multiple priorities while maintaining a positive attitude, and willingness to take on other duties as assigned.

Job Duties

• Manages team compliance with all applicable coding guidelines, rules and regulations related to coding and documentation guidelines for chronic conditions, thereby validating diagnosis codes to ensure supported by the medical record documentation.

• Reviews medical records, patient medical history & physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative & pathology reports, and discharge summaries.

• Analyzes medical claims data and associated documentation for purpose of assuring accurate and complete diagnostic risk capture; documenting findings, diagnosis code changes, and opportunities for documentation improvement.

• Manages and audits Coding Vendor and encounters submitted to CMS for accuracy of ICD-10 code selection, as well as identifying when the deletion of ICD-10 codes are necessary due to unsubstantiated records.

• Selects, hires, and onboards new team members, while managing a team of coder's workflows, work assignments, and the evaluation of the performance of individual team members.

• Evaluates coding & documentation trends and identifies recommendations for provider engagement. Ensure the diagnosis codes for each acute/chronic medical conditions have been captured and submitted within the permitted timeframe.

• Monitors coding vendor reports for accuracy and regular updates by adding/deleting files for CMS encounter submission, provider engagement tools, and reference guides for provider engagement on documentation accuracy.

• Monitors and maintains current standards for all regulatory and coding guideline updates; and communicates updates as necessary to leadership.

• Performs other related duties as assigned.

The above statements describe the general nature and level of work only. They are not an exhaustive list of all required responsibilities, duties, and skills. Other duties may be added, or this description amended at any time.

Remains knowledgeable on current federal, state and local laws, accreditation standards or regulatory agency requirements that apply to the assigned area of responsibility and ensures compliance with all such laws, regulations and standards.

This employer maintains and complies with its Compliance & Privacy Program and Standards of Conduct, including the immediate reporting of any known or suspected unethical or questionable behaviors or conduct; patient/employee safety, patient privacy, and/or other compliance-related concerns. The employer is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status.

Physical and Environmental Demands

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.

Sedentary Work

• Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time) and/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.

Normal routine involves no exposure to blood, body fluid or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid.

The incumbent has no occupational risk for exposure to communicable diseases.

Because the incumbent works within a healthcare setting, there may be occupational risk for exposure to hazardous medications or hazardous waste within the environment through receipt, transport, storage, preparation, dispensing, administration, cleaning and/or disposal of contaminated waste. The risk level of exposure may increase depending on the essential job duties of the role.

Are you ready to make a difference? Apply Today!

Ochsner Health does not consider an individual an applicant until they have formally applied to the open position on this careers website.

Individuals who reside in and will work from the following areas are not eligible for remote work position: Colorado, California, Washington, New York, and Washington D.C.

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