ICD-10 Quality Assurance & Education Manager

Location:  New York City / Manhattan

Organization:  Acute Care Hospital

Overview: World-class acute care hospital, closely affiliated wtih the NewYork-Presbyterian Hospital System, is seeking an ICD-10 Quality Assurance & Education Manager to provide support, lead and execute the Hospital’s ICD-10 transition program (including impacts to HIM, compliance, clinical documentation, physician documentation, revenue cycle, finance, decision support, managed care contracting and data analysis).

Post ICD-10 transition, the ICD-10 Quality Assurance & Education Manager will work closely with Revenue Cycle, Patient Accounting and HIM to resolve unbilled account issues and to identify and resolve obstacles and inefficiencies that delay timely coding and abstracting.

Primary Functions:

Education
• Provide ICD-10 educational support for employees and contracted resources
• Educate coding staff, CDIS, physicians and others throughout the organization who require ICD-10 coding and documentation knowledge (training to include ICD-9, ICD-10, CPT, HCPCS, IPPS, OPPS, APC, DRG and other relevant state and federal laws and regulations)
• Provide expert guidance on ICD-10 coding and DRG assignments to the Revenue Cycle and Managed Care staff

Denial Management
Assists with working ICD-10 coding related denials and provides feedback to each provider based on identified denial trends or assists in appeals if payer ICD-10 application or logic is invalid. Implement changes and provide education & feedback to providers, departments and clinics with regards to denials that impact revenue flow and or capture.

Conducts research and analysis of claims data and medical records information to determine the accuracy of payment, appropriateness of coding, and adequacy of supporting clinical documentation as directed by ICD-10 Director; works collaboratively with Health Information Management, Managed Care, Quality, Clinical Documentation, Physician Services, Rehab etc. to resolve cases.

Quality & Compliance
Assist HIM & CDI Management staff to develop ICD-10 coding & CDI audit schedule. Assist in performing quality audits on internal coding. Develop and provide individualized training based on audit findings.
Assist the Quality and CDI department in creating ICD-10 compliant electronic templates for documentation in the EMR.

QUALIFICATIONS:

  • Bachelors Degree (REQUIRED) 
  • Advanced Degree (PREFERRED)
  • AHIMA or AAPC Coding Credential (REQUIRED)
  • AHIMA ICD-10-CM/PCS Certified Trainer (REQUIRED)
  • Minimum of 5 - 7+ years of leadership experience in HIM/Revenue Cycle (REQUIRED) 
  • Strong conceptual as well as quantitative and qualitative analytical skills (REQUIRED) 
  • Minimum of 2+ years of ICD-10 experience; 
  • Strong organizational skills, including ability to prioritize tasks and delegate when appropriate (REQUIRED) 
  • Flexibility and responsiveness in managing multiple projects simultaneously; prior experience managing large complex projects (REQUIRED) 
  • Well developed written and verbal communication skills, including the ability to positively interact with executives, providers and staff at all levels; strong facilitation and presentation skills (REQUIRED) 
  • Significant experience using project management software is preferred.
  • Epic Experience and Certification are a plus

For a copy of the formal job description, compensation and other employer details, please submit your resume and contact information on the right.