Coding Director - Central Coast, CA

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)

The Services Area Director, Coding is responsible for the 7-day per week operations of Coding department which includes: developing and implementing a data quality management plan for coding and reimbursement which includes: facilitating the structure, process, oversight and accountability of the service area for health data collection activities to ensure accurate provider documentation, compliant and optimal reporting and reimbursement of health care services.   

This position reports to the Senior Director, HIM & Coding. The incumbent's primary responsibility include developing and maintaining good communications and working relationships with the medical staff, administrative staff, outside agencies and with other departments. 

The key working relationships of the Director, Coding include:

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  Internal: Facility Leadership, Administration, Risk Management, Health Information Management, Patient Financial Services, Quality Management,  Utilization Management Registration/ Admitting Services, Nursing, Ancillary Services, Dignity Health Legal Counsel, Medical Staff, Medical Staff Office,  Human Resources, Information Technology Services, Facility Compliance Liaison, Clinical Informatics , Corporate Health Information Management Operations and Corporate Compliance


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  Committees: Quality Committee, RAC Committee, Revenue Cycle Committee, Denials Committee, Revenue Integrity Committee


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  External: Consultants, Trading Partners and Business Associates, Federal, State and Accrediting Agencies, and Other Covered Entities

The Director, Coding upholds the best interests of Optum 360 by adhering to the highest standards of ethical and moral conduct and by committing to the values of Dignity Health's mission and philosophy.

Primary Responsibilities:

• Designs and maintains the physical environment by organizing personnel and equipment within the space and budget available; arranges the physical environment to facilitate smooth workflow; optimizes space efficiency to ensure safety


• Assist with annual capital and operating budgets for the Coding Department and ensures the financial stability and expenses remain within budget


• Plans and directs coding and compliance program which includes coding for the hospital facilities, ambulatory surgical services, outpatient services and clinic based services and assuring that coding practices meet all the correct coding and compliance standards


• Identifies patterns, trends and variations in coding or claim data submitted and taking appropriate steps in collaboration with departments to effect resolution or explanation of the variance; performing analysis to identify risks and gaps


• Implements processes and procedures to capture coded data to assure accurate and timely coding


• Assesses current coding productivity standards and develops a strategic plan to improve organizational effectiveness


• Oversees audit coding plan and responds to findings and recommendations of external compliance assessments and audits as it related to coding issues; prepares appeals when appropriate


• Ensures that information systems support current and future needs of the department; works closely with information technology in transition planning including, but not limited to, testing, installation and education of staff to produce and maintain high quality coding and data integrity


• Ensures compliance with external agencies and state and federal regulations; develops, maintains, and implements policies and procedures; evaluates and improves the effectiveness of policies and procedures and workflow


• Monitors the initiation, revision, and implementation of external regulations, statues, and standards; facilitates implementation of revised regulations; ensures conformance


• Serves as the facilities liaison for coding and reimbursement and attending revenue cycle, chargemaster, compliance and other related meeting


• Ensures the Coding department sufficiently provides efficient and effective services; reviews and approves personnel matters pertaining to interviews, hires, evaluations, counseling, training and makes recommendations for termination for staff as appropriate; review provisions for staff development, training, and orientations as prescribed by Dignity Health and departmental standards


• Implements a reporting system that incorporates a reasonable span of control including time and resource allowances to effectively perform services and communicate; organizes the department in such a way that decisions are made and problems are solved at the appropriate level


• Motivates and empowers staff in the successful performance of their tasks and responsibilities to support Dignity Health facilities needs and encourages innovation


• Maintains adequate dialogue with direct reports and employees and maintains at least monthly staff meetings  Make formal and informal presentations both orally and in writing; provides direct reports with the resources, tools, and training they require to meet expected performance levels; provides feedback on direct report's performance and make recommendations for improvement


• Utilizes result of quality control monitoring as an integral part of employee performance appraisals; Monitors, evaluates, appraises or disciplines employees activities according to Dignity Health standards


• Actively participates in various committees such as, but, not limited, to the Medical Records Committee, Revenue Cycle Committees, Documentation Improvement Committee, and regional Electronic Health Record related Committees


• Other duties as assigned

Required Qualifications:     

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  Bachelor's or Associate's Degree in Health Information Management or related field


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  RHIA or RHIT credential


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  5+ years of experience in a management level position in a hospital or healthcare system


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  Experience with the electronic health record, health information systems and healthcare applications


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  Experience with regulations and accreditation standards, knowledge of specific state and federal requirements and standards related to the management of health information


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  Knowledge of ICD-9, ICD-10, CPT, and APC coding guidelines


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  Maintain professional relationships with state and national organizations to gain insight and understanding of future trends, regulations, ect.


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  Expertise in health information management, best practices, processes and procedures; knowledge of medical terminology, classification systems, and vocabularies


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  Demonstrates leadership skills and exercises judgment within generally defined practices and policies when selecting methods and techniques in problem solving


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  Takes the initiative to make decisions and is an advocate for change


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  Demonstrated experience in developing and implementing facility-wide policies and procedures, and identifying and resolving operational issues


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  Experience in assessing and identifying learning needs as well as providing education and training designed to support a learning organization


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  High ethical standards


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  Excellent written and verbal communication skills, including the ability to present ideas and concepts effectively across organizational levels


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  Possess a strategic and problem solving orientation and superior planning and organizational skills


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  Knowledge of information privacy laws, access, release of information, and release control technologies


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  Knowledge of hospital protocols and procedures


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  Working knowledge of functional relationships between departments within a healthcare or similar environment


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  Knowledge of JCAHO, HIPAA, HCFA, Title 22, security principles, guidelines, and standard healthcare practices


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  Demonstrated competence with personal computers, networks, and Microsoft Office

Preferred Qualifications:

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  CCS credential

Health care isn't just changing. It's growing more complex every day. ICD10 replaces ICD9. Affordable Care adds new challenges and financial constraints. Where does it all lead? Hospitals and health care organizations continue to adapt, and we are a vital part of their evolution. And that's what fueled these exciting new opportunities. Optum360 is a dynamic new partnership formed by Dignity Health and Optum to combine our unique expertise. As part of the growing family of UnitedHealth Group, we'll leverage all our resources to bring financial clarity and a full suite of revenue management services to health care providers nationwide. If you're looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: Coding Director, Director of Coding, Central Coast, California, CA