In accordance with Department policies and procedures, the Assistant Director, Coding, has the following duties and responsibilities:
1. Plans, manages, and monitors all operational, administrative, and personnel aspects of coding unit operations. Establishes unit goals and objectives.
2. Supports an effective DRG Validation Program. Identifies case selection criteria and continually evaluates the effectiveness of criteria and modifies as necessary.
3. Supports an effective physician query process. Assists in evaluating the effectiveness of the process and refers identified issues to the Associate Director.
4. Provides training, development, and support to coding unit staff members, physicians, other health care providers, and other Departments, focusing on trends identified through the validation process, new coding guidelines, and updated billing requirements. Develops and/or provides resources for staff development and education.
5. Develops and implements unit quality improvement activities. Identifies areas of vulnerability.
6. Ensures compliance with external reporting requirements, including SPARCS, DOH Congenital Malformation reporting, and DOH Sterilization reporting.
7. Monitors staff productivity and takes actions necessary to maintain required performance standards.
8. Develops, implements, and maintains unit policies and procedures, job descriptions, and performance standards.
9. Oversees all aspects of personnel management functions including hiring, training, scheduling, timesheet processing, evaluating, counseling, and terminating employees.
10. Attends inter-departmental meetings as required.
11. Performs the duties of an MRS/AMRS/SMRS if required.
12. Thoroughly reads and interprets the documentation in the entire on-line and hard-copy medical record to identify all diagnoses and procedures for coding.
13. Validates the completeness, accuracy, and specificity of ICD-10-CM and CPT-4 code assignment for inpatient, outpatient, and Ambulatory Surgery records in accordance with established coding guidelines, including AHA Coding Clinic and AMA-CPT Assistant. Ensures that all documented diagnoses and procedures are coded.
14. Validates the accuracy of DRG assignment.
15. Validates the accuracy of additional information abstracted from the clinical record including discharge disposition, present on admission (POA) indicator, attending physician, and other abstracted information with an impact on coding, severity of illness, casemix, and reporting.
16. Validates that physicians have been queried according to the established procedure whenever there is an opportunity to improve documentation that impacts coding. If a missed opportunity to query has been identified, refers the case back to the Clinical Documentation Improvement Specialist (CDIS), Coder, or Associate Director as appropriate.
17. Refers all cases with an opportunity to modify the ICD-10-CM/CPT-4 codes, the DRG assignment, or other abstracted information, back to the appropriate Medical Record Specialist or Associate Medical Record Specialist for correction. Discusses recommended changes with appropriate staff member to ensure agreement and/or understanding.
18. Responds to IPRO and other third party coding-related denials.
19. Performs other department functions as needed.