Coding and Documentation Specialist/HIM Supervisor FT 2026-6975

Cambridge Memorial Hospital; Cambridge; On-site; CAD 63,000 - 74,000; Full time

Benefits offered by this job

HOOPP pension plan

Health & Dental benefits

Employee & Family Assistance Program

Education grant

Wellness & Wellbeing Program

Diversity & Inclusion initiatives

Job summary

Cambridge Memorial Hospital (CMH) in Cambridge, Ontario, is seeking a Coding and Documentation Specialist/HIM Supervisor with expertise in acute care coding, NACRS and DAD abstraction, and HBAM funding. This full-time role involves leading the coding team, educating physicians, and maintaining data quality for QBPs.

You will drive audits, implement CIHI changes, and ensure confidentiality and compliance with PHIPA while supporting high standards of patient care and data integrity.

Qualifications

• Graduate of an accredited Health Information Management program required.
• Certification with the Canadian Health Information Management Association (CHIMA) in good standing.
• Minimum 5 years of current experience coding NACRS and DAD and abstracting.
• Supervisory and leadership experience.
• Experience providing group education.
• Proficiency with electronic abstracting and computer applications (Word and Excel). Experience with Meditech and 3M would be an asset.
• Excellent skills for case analysis and interpretation for ICD-10 with ICD-11 planning.
• Knowledge of grouping/weighting methodologies (CMG, HIG, RIW, Complexity, CACS, ACW).
• Knowledge of HBAM, QBP, PCOP hospital funding methodologies.
• Ability to apply quality practices to coding/abstracting and work under pressure.

Responsibilities

• Foster relationships between the various disciplines.
• Liaison between clinical and business side of healthcare.
• Facilitate extensive day-to-day interactions with coding, decision support and physician groups.
• Establish process for chart review and opportunities for improvement affecting HIG weight, QBPs, HSMR and LOS.
• Query physicians to clarify documentation for accurate coding.
• Present findings and ensure timely, complete documentation used for outcomes and decision making.

Skills

Leadership experience

Communication skills

Time management

Quality assurance

Independent work

Education

Health Information Management degree

CHIMA certification

Tools

Meditech

3M

Microsoft Word

Microsoft Excel

Job description

Overview

Join a hospital where everyone makes a difference! Cambridge Memorial Hospital (CMH) is a thriving community hospital that proudly provides acute care services including: Emergency, Surgery, Medicine, Women’s and Children’s Health, Intensive Care, Mental Health, and Inpatient Rehabilitation.

Our vision is to creating healthier communities togethere. Our dedicated and skilled staff are passionate about providing outstanding patient-centred care, and an exceptional patient experience to residents of the Waterloo Region and beyond.

Why Should You Apply to CMH?

• Healthcare of Ontario Pension Plan (HOOPP)
• Group Benefits, including Health & Dental, for full time employees
• Employee & Family Assistance Program
• Career Development & Education Grant
• Wellness & Wellbeing Program

Diversity, Equity & Inclusion Initiatives

Come be part of our vision as CMH leads in innovation and compassion! To learn more about CMH, please visit our website at www.cmh.org.

Job Description

Salary Range: $45.62 - $54.30

Position Summary

Coding and Documentation Specialist/HIM Supervisor must be experienced and knowledgeable of all types of acute care coding and coding standards. In addition, the Coding and Documentation Specialist/HIM Supervisor must have good knowledge of HBAM funding methodology. The Coding and Documentation Specialist/HIM Supervisor will facilitate improvement in the overall quality, completeness and accuracy of medical documentation to ensure coded data reflect the care provided to patients. This role is accountable to work with physicians and coders to ensure that documentation reflects the complexity of illness. This includes; review of clinical documentation, regular coding audits, provide orientation to new physicians focusing on expectations and common documentation issues/challenges within their specialty.

The Coding and Documentation Specialist/HIM Supervisorwill regularly attend physician specialty meetings to highlight documentation issues and address with individual physicians. Arrange regular coding meetings, educate coders, review & implement annual CIHI changes and requirements for QBP funding, act as a resource for complex charts, review and monitor queries to physicians, Project 100 and ensure all corrections are submitted prior to the end of the reporting period. Maintain strict confidentiality of all patient information in accordance with PHIPA.

This is a full time position to work days Monday to Friday.

The physical demands of the role may include, but are not limited to prolonged sitting, standing, walking, bending, lifting, pushing and pulling. This position contributes to ensuring there is a safe environment for patients, staff and visitors.

Posted hours do not constitute a guarantee that shifts will not be subject to change.

Key Responsibilities and Accountabilities:

• Foster relationships between the various disciplines
• Liaison between clinical and business side of healthcare
• Facilitate extensive day to day interactions with the coding team, decision support and physician groups
• Establish process for flagging charts for review and facilitate chart review process including:
  • Evaluation of opportunities for improvement that impact HIG weight, QBPs, HSMR, Benchmark LOS
  • Query to physicians to gain clarity on documentation to ensure accurate code assignment
  • Summary of findings / results
  • Identify trends and education opportunities
  • Present findings
• Enable timely, accurate and complete documentation of clinical information used for measuring and reporting physician and facility outcomes and to ensure top quality data for decision making

Skills and Qualifications:

• Graduate of an accredited Health Information Management program required
• Certification with the Canadian Health Information Management Association (CHIMA) in good standing
• Minimum5 years of current experience coding NACRS and DAD and abstracting
• Supervisory and leadership experience
• Experience providing group education
• Proficiency with electronic abstracting and computer applications (Word and Excel). Experience with Meditech and 3M would be an asset
• Must have excellent skills for case analysis and interpretation for the ICD 10 coding classification with the expectation for implementing ICD 11 coding
• Must have an understanding and knowledge of grouping and weighting methodologies (i.e. CMG, HIG, RIW, Complexity, CACS and ACW)
• Must have knowledge of hospital funding methodologies HBAM, QBP, PCOP
• Ability to apply quality practices and standards to coding and abstracting.
• Ability to work independently, prioritize workload, meet deadlines and work effectively under pressure and show good judgment
• Familiar with relevant legislative requirements for release of personal information (Personal Health Information Protection Act, Mental Health Act, Public Hospital Act, Freedom of Information Act, Coroners Act etc.)
• Excellent customer service, interpersonal and communication skills are required
• Excellent organization and time management skills
• Demonstrated ability to attend work on a regular basis is required

As part of our commitment to the health and safety of our patients, staff and community from COVID-19, subject to any accommodation required by applicable human rights legislation, Cambridge Memorial Hospital requires that all staff have received all required doses of a COVID-19 vaccine approved by Health Canada.

The successful external applicant is required to provide the applicable criminal record check, as requested by Human Resources, in accordance with federal and provincial legislation. Valid criminal record checks are in original format and dated with two months from date of conditional offer from CMH.

CMH Inclusion Statement

At Cambridge Memorial Hospital (CMH), community matters to us. We acknowledge and are grateful for the opportunity to meet, work and offer healthcare on what is the traditional territories for the Anishinaabe, the Haudenosaunee and the Chinnonton.

We are committed to providing and fostering a respectful, caring, and inclusive workplace; one that generates belonging. We want a work culture where people are free to express their authentic selves and are able to bring their best daily. That includes a workplace that is free from violence, harassment and discrimination of any kind.

We welcome all applicants and encourage members of equity-deserving groups including Indigenous and LGBTQ2SIA+ communities regardless of race, gender, sexual orientation, gender identity or expression, lifestyle, age, educational background, national origin, religion, neurodiversity or physical ability. We promise to ask if needed, and to provide reasonable accommodation to you during the recruitment and selection process to ensure an equitable experience.

To support all of us in this journey, Cambridge Memorial Hospital is an employee partner with the Canadian Centre for Diversity & Inclusion (CCDI) and provides access to all CMH members to CCDI resources and education. We encourage you to reflect upon our inclusive commitment to you as we welcome and encourage you to explore a promising future career at CMH.

Mari Iromoto Executive Champion Diversity, Equity and Inclusion

Melissa Duguid, Director of Human Resources

We thank all those who apply, however only those selected for an interview will be contacted.

Cambridge Memorial Hospital (CMH) proudly integrates AI-based technologies into its applicant screening process to enhance recruitment. These tools are designed to reduce bias and uphold fair hiring practices based on skills, education, and experience. CMH’s AI serves to assist, not replace, human decision-making, with results audited to ensure quality and equity. This initiative reinforces the hospital’s commitment to Equity, Diversity, and Inclusion, ensuring the best talent is selected while adhering to its core values.

Union

Non-Union