The Data Quality Supervisor oversees the day-to-day coding audit/analyst workqueues, work assignments, personnel, and serves as a subject matter expert regarding but not limited to DRGs, APCS, ICD-10CM/PCS diagnoses and procedure codes for internal and external team members. In addition, the supervisor codes/audits accounts on a weekly basis. Provides trending feedback, applicable trending reports, and delivers education within department within areas of expertise.
The Data Quality Supervisor will use their knowledge and their teams to identify potential documentation, coding and reimbursement issues and report these to the Data Quality Manager and implement process improvements. The Data Quality Supervisor will gather this data in a presentable format to communicate to leadership, the coding/auditing staff as well as other leaders at WellStar, as directed. The Data Quality Supervisors will make quality improvement recommendations by identifying trends pulled from their insights as well as their team's insights and participate in implementing process improvements. The Data Quality Supervisor will provide/deliver executive style written and verbal reports to include analysis of metrics within owning area to leadership.
Core Responsibilites and Essential Functions Team Supervision
* Monitor Auditing/Analyst work queues and auditing software to ensure compliance to Coding CFB, team goals and turnaround times are met. Assess/manages/assigns daily work/volumes. Directs and adjusts staff to volumes, PTO, vacancies, request for overtime, etc. to ensure team and CFB goals are met, seeking budgetary and managerial approval when needed.
* Direct daily operational needs throughout the day for Auditing/Analyst Team. Troubleshoot issues within the team as well as internal/external customers.
* Perform staff evaluations, coaching, and constructive feedback as needed. Deliver praise, positive feedback/reinforcement when applicable.
* Lead productive and timely team and 1-1 meetings with staff. Deliver quality/productivity metrics on team meetings and with individual staff. Ensure all staff meet required metrics and address both positive and negative results. Assist with recognition and process improvement plans.
* Manage staff time/hours/approvals within Kronos.
* Conduct thorough and prepared interviews and hire competent team members.
* Implement process improvements within scope of work as well as motivational and team building activities. Connect with staff positively and leverage individual’s strengths in an effort to use resources in the most effective manner.
* Conduct sporadic or specified coding audits to ensure quality team is meeting quality metrics
* Monitors daily staff productivity.
* Enforce accountability to WellStar Polices and Owning Area Policies and Procedures. Serves as a Subject Matter Expert for, but not limited to
* PSIs, Vizient methodology, IMO Code requests, 2nd opinion requests from team, other requests from internal/external customers, etc.
* Investigating and responding to coding questions related to areas of expertise (i.e. inpatient, outpatient, and/or ED coding).
* Manage updates for the ‘Internal Departmental Coding Guidelines’. Communicate to internal/external customers upon approval from Manager.
* Review coding updates/trends from various sources and then communicates to Manager/Executive Director.
* Participate in identifying trends and issues for improvements from review of records, team feedback/meetings, and/or reports.
* Test software for owning area’s workflows, updates, new initiatives, etc. Maintains Reporting Profiles/Dashboard Metrics
* Maintains Coder Profile monthly.
* Monitors Auditing software for corrections at least weekly.
* Monitors Auditing software and/or reports for validity of Productivity Worksheets at least weekly. Maintains/Updates Productivity and Quality Auditing Spreadsheets and provides deliverable reports from metrics monthly.
* Creates and maintains updated instructions and tip sheets for all processes/software within scope of work for Auditors and Denial Analysts.
* Provides/maintains other reports to include but not limited to: Prebill and Mortality Auditing Results, Coder focused results, etc. Education
* Oversees management of onboarding of new coders to include but not limited to attending onboarding calls, communicating quality metrics to Data Quality and Coding Managers, and ensuring onboarding processes are followed.
* Onboard new Auditors/ Analysts to include contractors, if necessary.
* Interpret trending errors/reports to make recommendations based on results.
* Provide education within the department to include, but not limited to: trending errors, new code updates, etc.
* Refer to outside sources for additional education, as needed: 3M Nosology, Coding Clinic, CMS Website.
* Advocate for issues and improvement opportunities on behalf of owning area. Codes/abstracts/audits accounts and resolve inpatient and outpatient coding denials on a weekly basis to maintain skills and assist in covering workload. Assists with Coding Analyst responsibilities as needed:
* Accurately and completely assigns appropriate ICD-10 CM/PCS and/or CPT/HCPCS codes to the greatest specificity with a minimum 95% accuracy rate.
* Accurately and completely abstracts all required data into the appropriate data fields in compliance with statistical data requirements with a minimum of 95% accuracy rate.
* Accurately assigns correct APC at a minimum 95% accuracy rate.
* Meet productivity standards.
* Queries physicians to further clarify code assignments, if needed.
Perform Coding Audits
* Validate that the codes, abstracted data and DRGs under focused review are assigned according to official coding guidelines and supported by clinical documentation in the medical record.
* Identify documentation improvement opportunities in DRG, APC, CPT, ICD-10 CM/PCS codes, POA, Point of Origin, Place of Transfer, and Discharge Disposition, and other coding and documentation elements, as needed.
* Provide feedback to coding staff on areas of opportunity.
* Validate adherence to WellStar Coding Policies and Procedures.
* Validate adherence to WellStar Coding Query Policy. Other duties as assigned i.e. (not limited to)
* Attend and provide notes back to the Manager for meetings: OCC, Denials, etc. Support other roles within the department.Participate as a Coding representative in meetings.
Required for All Jobs Performs other duties as assigned Complies with all WellStar Health System policies, standards of work, and code of conduct.
Required Minimum EducationHigh school diploma Anatomy Required and Physiology course Required Registered Health Information Administrator (RHIA) Required and Registered Health Information Technician Required or Certified Coding Specialist (CCS Required Bachelor's Degree Health Information Management Preferred and Business Preferred or other health care related field Preferred
Required Minimum Experienceminimum 5 years hospital-based inpatient/outpatient services coding experience currently meeting a 95% accuracy in abstracting, coding and DRG assignment while meeting productivity requirements or passing score on the coding assessment provided by Coding department Required and Previous auditing in an acute care setting and supervisory or lead experience Preferred and demonstrate extensive experience with DRG assignment and hospital coding of diagnosis and surgical procedures with outpatient coding experience Preferred and
Required Minimum Skills Articulate with critical thinking skills. Ability to use Microsoft Office Suite to include but not limited to Word, PowerPoint, and Excel as well as have operational computer knowledge to manage a large team in a virtual environment which includes web conferencing, email, instant messaging, and other forms of digital technology. EMR (electronic medical record) knowledge and navigation experience in Epic, 3M, Vizient, HealthStream, Cloudmed, and AudaPro preferred. Excellent organizational and multi-tasking skills abilities required. Ability to formulate oral and written data in an executive style format to leadership. Ability to represent data professionally and appropriately within owning role to leadership. Extensive experience with Medicare, Medicaid, and reimbursement rules and regulations on all payors.
Required Minimum License(s) and Certification(s)
Additional Licenses and Certifications