Repost-Health and Information Manager I

THIS POSITION HAS BEEN REPOSTED. PREVIOUS APPLICANTS NEED NOT APPLY.

The Department of Mental Health is a drug-free workplace. All candidates will be required to pass a mandatory pre-employment drug test.

This position is located at the Department of Mental Health, Central Office, 2414 Bull Street, Columbia, SC 29201 .

Under general supervision this position coordinates the staff responsible for coding and posting of physician and ancillary charges, charge capture, and assisting with staff and physicians education in each of these areas. Key responsibilities include day to day management of these functions as well as serving as a member of operational leadership committees on related matters. This individual is a leader in revenue cycle and compliance functions across the organization.

Directs and manages coding processes, policies, and education.

Ensures that regular quality assurance reviews of coding are performed by coding and clinical department staff.

Interprets external policies ensuring compliance by the practice plan regarding coding, reimbursement and medical record releases including, but not limited to those of CMS, Medicaid, managed care and commercial insurers, American Hospital Association (AHA),American Medical Association (AMA), and American Health Information Management Association (AHIMA).

Assists in the implementation of new software for revenue cycle use including adapting workflows for clinical departments as well as direct reporting departments to utilize the system most efficiently.

Develops institutional guidelines, procedures and standards regarding coding and posting in order to communicate expectations (i.e., standards) to physicians, residents and staff, and to promote compliance and ensure reimbursement.

Analyzes new programs and services provided by Agency. Determines appropriate codes for these services. Meets with physicians and staff; discusses components of service in order to make a decision regarding which codes (for diagnosis and procedure) should be used. Researches and investigates various insurers (Medicare, Medicaid, managed care, indemnity plans, etc.) to project reimbursement.

Identifies and resolves low reimbursement of services. Determines if appropriate coding and billing processes are being carried out, or if insurer has modified requirements for payment/coverage.

Monitors complex reimbursement policies and identifies, in collaboration with the compliance and IT department and, the rules to add, or modify in claims edit systems to reduce the number of rejected claims and lower days in accounts receivable.

Analyzes difficult account problems and claim denials related to coding issues and approve account maintenance adjustments in compliance with Department, and third party payer guidelines.

Provides special reports or attachments necessary to explain services to individual, Federal, State, and insurance carrier claims to insure appropriate payment.

Serves as a member of the Compliance Committee and Billing Users Group.

Conducts in-services for faculty, residents, and staff to provide education on coding, billing, documentation, and compliance issues in accordance with rules set forth by the CMS, Medicaid, managed care and commercial insurers, etc

Excellent verbal and written communication skills

Understanding of the business concepts and regulatory environment necessary to comply with healthcare standards and medical staff practices.

Broad knowledge of computer systems, EMRs and related technology (not all inclusive) for coding, transcription/speech recognition, imaging, documentation, Computerized Physician Order Entry (CPOE), patient portal, etc. used in the healthcare environment

Ability to lead and engage others, develop resources and seek educational opportunities to enhance staff ability to transition with healthcare changes.

Project professionalism and strong work ethic.

Demonstrate collaborative leadership with implementation of electronic technology related to the entry, access and retrieval of Protected Health Information (PHI). Support implementation, user training and education, and oversight of HIM IS modules

Design process-driven practice standards for accuracy, completeness, security, confidentiality, use and disclosure of PHI.

Minimum and Additional Requirements:

State Requirements: A bachelor’s degree with accounting courses and professional experience in a related area such as accounting, auditing, banking or finance.

Agency Requirements: A bachelor’s degree in Health Information Management or a related field and 5 years of experience coding (ICD and CPT) hospital and/or physician services. Certification as an RHIT or RHIA.

Note: If any Agency Requirements are listed above, applicants must also meet those requirements to be considered for the position.

Preferred Qualifications:

Certification of coding expertise by either American Health Information Management Association or the American Academy of Professional Coders,

Knowledge of physician and hospital reimbursement.

Three years supervisory experience, preferably of coding staff.

Expertise in health information management and release of information laws and policies.

Additional Comments:

Supplemental questions are considered part of your official application. Please complete the state application to include all current and previous work history and education. A resume may be attached, but not substituted for completing work history and education sections of the employment application. The employment application will be considered incomplete and not forwarded.