At White Plains Hospital, you have an opportunity to work side-by-side with some of the most talented people in the world.

We have been widely recognized for our exceptional culture, world-class physicians, Magnet-designated nurses and passionate employees who make a real difference in our community. With tremendous growth opportunities, great benefits, and flexible work schedules, it is no wonder why we are consistently recognized as a Great Place to Work.

Position Summary:

The 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 Functions and Responsibilities Includes the Following:

Understands and adheres to WPH Performance Standards, Policies and Behaviors Keeps 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. Acts as a positive resource to organizational personnel and fosters goodwill between departments and external parties which are part of the operational interactions of HIM. Performs all other related duties as assigned

Education & Experience Requirements

Bachelor’s degree required. CCS 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.

Core Competencies

Demonstrates ability to promote Teamwork among all HIM Staff

Demonstrate 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 work

Physical/Mental Demands/Requirements & Work Environment

May 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 locations Must be able to concentrate during times of increased noise level, changes in temperatures

Primary Population Served

Check appropriate box(s) below:

☐Neonatal (birth – 28 days)

☐Patients with exceptional communication needs

☐Infant (29 days – less than 1 year)

☐Patients with developmental delays

☐Pediatric (1 – 12 years)

☐Patients at end of life

☐Adolescent (13 – 17 years)

☐Patients under isolation precautions

☐Adult (18 – 64 years)

☐Patients with cultural needs

☐Geriatric (> 65 years)

☒All populations

☐Bariatric Patients with weight related comorbidities

☐ Non-patient care population

 

The responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of White Plains Hospital.