Coding Manager DRG Validator - Hybrid

White-Plains-Hospital; City of White Plains (NY); On-site; USD 94,000 - 141,000; Full time

Job summary

White Plains Hospital Medical Center is seeking a Coding Manager/DRG Validator to lead the inpatient coding operations within the Health Information Management (HIM) Department. The role focuses on accurate code abstraction, DRG assignment, and data quality to optimize reimbursement and compliance.

The ideal candidate will have a CCS certification, RHIA or RHIT credentials, seven+ years of coding experience with at least five in management, and proven leadership in a hospital setting.

Qualifications

• Bachelor's degree in health information management or related field.
• CCS certification is required.
• RHIA or RHIT credential preferred.
• Seven+ years of coding experience; five+ years in coding management in acute care.

Responsibilities

• Oversee inpatient coding operations and DRG validation.
• Ensure compliance with federal/state regulations and hospital policies.
• Lead, train, and evaluate HIM staff; drive process improvements.
• Collaborate with Patient Accounts and other departments to optimize reimbursement.

Skills

Leadership

Healthcare coding

DRG expertise

Compliance knowledge

Education

Bachelor Degree

CCS Certification

RHIA or RHIT credential

Job description

City/State:White Plains, New YorkDepartment:Health Information Management_2Work Shift:DayWork Days:MON-FRIScheduled Hours:9 AM-5 PMHours Per Pay Period:75Pay Rate/Range:$93,829.13 - $140,754.51Job SummaryThe Coding Manager/DRG Validator oversees the daily operations of the HIM Department inclusive of Inpatient Coding, with responsibility for all processes and procedures including abstracting clinical information from a variety of Electronic Health Records and assignment of appropriate codes for diagnoses and procedures. The Manager/DRG validator is responsible for creating consistency and efficiency in inpatient claims processing and data collection to optimize DRG reimbursement and facilitate data quality in hospital inpatient services.Essential FunctionsUnderstands and adheres to WPH Performance Standards, Policies and BehaviorsKeeps abreast of all pertinent federal, state and WPH regulations, laws and policies as they presently exist and as they are changed or modified.Ensures that all staff are trained and evaluated on their knowledge of and adherence to compliance policies and procedures specific to their job.Assures timely transmission of coded data to Patient Accounts Department.Serves as hospital resource on coding and DRG reimbursement.Oversees all compliance reviews especially Inpatient cases as necessary; initiates education/or corrective actions as necessary.Shares findings of coding reviews with Coders on a regular basis; initiates/education or corrective actions as necessary.Assures compliance with state regulatory and accreditations standards.Interviews, hires, trains, evaluate, counsels and terminate employees as per hospital policy.Conducts staff meetings as needed to update staff and/ or address department issues.Participates in committees, task forces, projects as required.Facilitates work with outside agencies with implementation of coding/cdi documentation improvement to ensure best practices which include compliance and increased revenue.Is responsible and accountable for overall operations of areas of responsibility within the HIM Department; overall operations include participation in the development of LEM goals that are consistent with the Hospital Pillar Goals, the management of personnel, monitoring of HIM budgets.Assists staff as needed to complete work, ensures that all expected standards in the process are working optimally, and pays attention to accuracy and turnaround time commitments.Identifies opportunities to streamline current operations where possible and implements approved procedural changes, problem solves, troubleshoots, and appropriately escalates issues to higher level management as necessary.Identifies opportunities to streamline current operations where possible and implements approved procedural changes, problem solves, troubleshoots, and appropriately escalates issues to higher level management as necessary.Performs all other related duties as assigned.QualificationsBachelor Degree RequiredCCS Certification required.RHIA or RHIT credential preferred.Minimum of Seven (7) years of coding experience; with at least Five (5) years of Coding management experience, in acute care hospital Health Information Department; with extensive exposure to CPT-4 and ICD-10-CM-PCS coding, data entry and chart Clinical documentation.DRG Validation experience: Include excellent understanding of coding guidelines and in depth understanding of MS-DRG, and APR-DRG groupers to ensure optimal results for hospital in order to maintain high compliance and optimal reimbursement.Demonstrates ability to promote Teamwork among all HIM StaffDemonstrate leadership skills and empower staff to hardwire communication skills bidirectional.Must demonstrate excellent organizational, judgment, communication, and problem-solving techniques.Demonstrate stress tolerance with all exchanges of daily workMay be exposed to chemicals necessary to perform required tasks. Any hazardous chemicals the employee may be exposed to are listed in the hospital’s SDS (Safety Data Sheet) data base and may be accessed through the hospital’s Intranet site (Employee Tools/SDS Access). A copy of the SDS data base can also be found at the hospital switchboard, saved on a disc.Manual dexterity is required for use of computer keyboard and mouse; Must be able to sit at computer terminal for extended amounts of time daily.Walking to different areas both inside and offsite locationsMust be able to concentrate during times of increased noise level, changes in temperaturesWhite Plains Hospital Medical Center is an equal employment opportunity employer. White Plains Hospital Medical Center will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law.