Health Information Mgt Manager

Opelousas General Health System

Opelousas (LA)

In loco

USD 95.000 - 140.000

Tempo pieno

4 giorni fa

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Descrizione del lavoro

Opelousas General Health System seeks a Health Information Management Manager to plan, budget, and direct HIM and CDI services for the hospital and clinics. The role ensures accurate coding, compliant documentation, and timely revenue-cycle processes, while safeguarding the legal health record and regulatory compliance across federal, state and payer requirements.

The position emphasizes leadership, performance management, and collaboration with Revenue Cycle, clinical leadership and IT to

Competenze

Bachelor's degree in Health Information Management or a related field.
Master's degree in HIM, Health Administration or Business preferred.
RHIA or RHIT certification required or equivalent leadership experience.
5 years in Health Information Management including inpatient and outpatient coding or CDI.
4 years of supervisory or management experience.
Experience with Oracle Health (Cerner) EHR and Encoder systems preferred.

Mansioni

Directs coding operations across inpatient, outpatient, emergency and clinic settings; maintains DNFB targets.
Leads CDI program for inpatient services and supports risk adjustment/documentation quality.
Manages denials, audits and appeals; coordinates external audits and record requests.
Oversees documentation, coding and health record standards for system clinics; standardizes release of information processes.
Leads privacy, records management and MPI integrity; ensures HIPAA compliance and 21st Century Cures Act information blocking rules.
Drives leadership, staffing, budgeting and regulatory compliance; maintains credentialing and continuing education for staff.

Conoscenze

Coding management

CDI leadership

Revenue integrity

Auditing

HIPAA compliance

Staff leadership

Formazione

Bachelor's in Health Information Management

Master's in HIM / Health Administration

RHIA / RHIT certification

CCDS / CDIP / CPC (certifications)

Descrizione del lavoro

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Health Information Management Regular Full-Time Management Main, Opelousas, LA, US 1 Attachments

Summary

The Health Information Management Manager plans, budgets, organizes and directs Health Information Management and Clinical Documentation Integrity services for the hospital and its provider clinics. The position is accountable for complete, accurate and timely coding and documentation, which drives clean claims, appropriate reimbursement and a controlled unbilled (DNFB) balance. The manager also ensures the confidentiality, integrity and availability of the legal health record and compliance with federal, state, accreditation and payer requirements.

Essential Duties and Responsibilities

1. Coding and Revenue Integrity

Directs all coding operations: inpatient (MS-DRG and other payer-required DRG systems), outpatient, emergency and observation (APC/OPPS), and provider clinic coding (CPT, HCPCS, E/M and HCC risk adjustment).
Owns measurable unbilled targets and reports them weekly: DNFB dollars and days, coding turnaround , and aging of accounts held for coding.
Maintains an escalation process for coding holds and documentation delays, including missing diagnoses, emergency physician notes, discharge summaries and operative reports.
Sets and enforces coding productivity and accuracy standards; conducts internal coding audits and coordinates external audits.
Implements annual and quarterly code set updates (ICD-10-CM/PCS each October 1; CPT/HCPCS each January 1 and quarterly) with education and system updates.
Partners with Revenue Cycle, and Charge Description Master (CDM) to resolve coding-related claim edits (NCCI, MUE, scrubber and payer edits).
Manage outsourced and remote coding vendors, including contract terms, performance targets and audit results.

2. Clinical Documentation Integrity (CDI)

Leads the CDI program for inpatient services.
Supports accurate risk adjustment (HCC) documentation for Medicare Advantage and other value-based populations.
Ensures all physician queries are compliant with AHIMA/ACDIS query practice guidelines.
Monitors and reports CDI performance: case mix index, CC/MCC capture, severity of illness and risk of mortality, query volume, response rate and agreement rate.
Provides education for physicians, advanced practice providers and clinical staff.

3. Denials, Audits and Appeals

Manages coding and clinical documentation denials, including DRG downgrades, medical necessity and coding edit denials; prepares or oversees appeals.
Coordinates responses to external audits and record requests in conjunction with the RAC Auditor: RAC, MAC/TPE, UPIC, OIG, and Medicare Advantage and Medicaid managed care plan audits.
Tracks denial root causes and reports trends and corrective actions monthly to revenue cycle leadership.
Manages record deficiency tracking by provider for the hospital and enforces Medical Staff Bylaws and Rules and Regulations for timely completion of discharge summaries, operative reports, emergency notes, history and physicals, and authentications.
Maintains delinquent records at or below The Joint Commission threshold and reports delinquency to the Medical Executive Committee.

5. Provider Clinics

Oversees documentation, coding and health record standards for all system-owned provider clinics, including E/M guideline education for providers.
Standardizes scanning, indexing, release of information and record retention processes across all locations.
Ensures documentation and billing support meet the requirements of each clinic's designation.

6. Release of Information, Privacy and Records Management

Ensures patient right-of-access requests are fulfilled within HIPAA timelines and in compliance with 21st Century Cures Act information blocking rules, including patient portal access.
Manages subpoenas, court orders, legal holds, amendment requests and accounting of disclosures; oversees release-of-information vendors.
Partners with the the Compliance Officer on access audits, breach investigations and privacy education.
Maintains Master Patient Index (MPI) integrity, including duplicate record identification, merges and overlay correction.
Maintains the legal health record definition, designated record set and record retention and destruction schedules in accordance with Louisiana law and federal requirements.
Oversees birth certificate and vital records processing.

7. Data and Technology

Serves as HIM lead for EHR optimization, encoder and computer-assisted coding tools, document imaging, and EHR downtime procedures.
Evaluates emerging technologies, including AI-assisted documentation and coding, for accuracy, compliance and return on investment.
Produces a monthly HIM dashboard covering DNFB, coding turnaround, coding accuracy, delinquent records, release-of-information turnaround, CDI metrics and coding-related denials.

8. Leadership, Staffing and Financial Management

Keeps hospital administration informed of departmental activities, performance, risks and needs.
Develops, implements and revises HIM and CDI policies and procedures, and ensures compliance with The Joint Commission, CMS Conditions of Participation, Louisiana Department of Health and other regulatory requirements.
Sets annual department goals aligned with the hospital's strategic plan and monitors progress.
Staffs the department to productivity standards; recruits, hires, trains, develops and evaluates staff.
Prepares and manages the department operating budget, including vendor and outsourced coding costs.
Ensure staff maintain required credentials and continuing education, and maintains own AHIMA credentials.

Standards of Behavior

Employee must be both committed to and accountable for demonstrating supportiveness, etiquette, respect, vibrancy, integrity, communication, and excellence in service delivery by adhering to the behaviors specified in the Service Standards of Behavior.

Minimum Qualifications