Regional Manager, Clinical Review

Apply Now    
Job ID: 48723
Area of Interest: Management
Location: Easton, MD US
Hours of Work: M-F, 0800 - 1630
Job Facility: U of M Shore Regional Health
Employment Type: Full Time
Shift: DAY
What You Will Do:

JOB SUMMARY: Directs and supervises the functions of coding, abstracting, data collection and computer entry into MEDITECH or other data systems for SRH. Manages the hospital owned physician offices (Shore Medical Group) coding for Evaluation and Management review. Develops, recommends, and implements policies and procedures. Translates the overall objectives set by management into individual and collective objectives for staff and develops plans for accomplishing them. Provides training and communicates information from management to employees. Assists the director in accomplishing his/her duties and acts on his/her behalf during times of absence. ESSENTIAL FUNCTIONS OF THE JOB: 1. Supervises and directs the duties of the Clinical Information Reviewers across the system and evaluates performance. 2. Maintains knowledge of ICD-9-CM, ICD-10-CM/PCS and CPT with supervision of coding and abstracting functions. 3. Oversees Shore Medical Group physician’s hospital evaluation and management levels and procedure coding. 4. Responsible for the Shore Regional Health surgery centers’ procedural coding and charging. 5. Explains new initiatives to reviewers and insures that they understand and execute accurately. 6. Continually briefs reviewers with updates and changes that affect coding and data collection. 7. Maintains and oversees relevant reference material with appropriate inclusions. 8. Communicates and provides ICD-9-CM/ ICD-10-CM/PCS and CPT-4 coding revisions and addenda to Clinical Reviewers and Clinical Documentation Improvement Specialists. 9. Oversees data collection for clinical studies, research, statistical compilation and other trending functions. 10. Provides guidance and assistance to reviewers when deciding difficult coding cases and choice of appropriate codes. 11. Provides guidance and assistance to Clinical Documentation Improvement Specialists as it relates to regulatory and the coding/reimbursement functions. 12. Insures corporate coding compliance through internal and external chart audits. 13. Helps provide continuing education to reviewers for maintenance of coding credentials. Provides education and training for inexperienced coders toward goal of achieving certification. 14. Monitors incomplete coding abstract reports for best use of available resources to maintain totals at or below administratively defined monetary or dated thresholds. 15. Contribute to effective management of departmental function by: a. Ensuring System wide coverage for the coding functions. b. Assisting with the preparation of the annual budget and working within budget guidelines. c. Identifying and analyzing opportunities to improve the service provided; developing objectives and designing work flow strategies. d. Assuming responsibility for the department in the absence of the Director of Clinical Information Management. 11. Works in collaboration with the Director in all areas of departmental improvement and development. 12. Strives to achieve excellence of service as described in the CARE Commitments. 13. Responds to Shore Regional Health codes as appropriate. 14. Responsible for honest behavior in all matters. To the best of the employee’s knowledge and understanding, complies with all Federal and State laws and regulations. 15. Maintains the privacy and security of all confidential and protected health information. Uses and discloses only that information which is necessary to perform the function of the job. 16. Performs related duties as assigned.

What You Need to Be Successful:

MINIMUM EDUCATION, EXPERIENCE, AND LICENSE/CERTIFICATION REQUIRED: Bachelor’s degree, Master’s preferred in a health information management related field with current RN or CCS, RHIT, or RHIA credentialing. Minimum of five years experience in a health care setting, including knowledge of ICD-9-CM/ ICD-10-CM/PCS, and CPT coding. Demonstrated excellent verbal and written communication, interpersonal, analytical, and organizational skills. ~CB
We are an Equal Opportunity/Affirmative Action employer.  All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law. 
Apply Now