The Health Information Management (HIM) Manager at Upstate Family Health Center, Inc. (UFHC) is responsible for the efficient and effective management of health information services, ensuring compliance with all relevant regulations and standards. The HIM Manager will lead the HIM department, maintain and secure patient records, and support the organizations Patient-Centered Medical Home (PCMH) and Federal Tort Claims Act (FTCA) certifications. This role involves collaboration with clinical and administrative staff to ensure that patient data is accurate, accessible, and secure. HIM Manager will also assist with identifying and monitoring performance measurements, and advising on information technology and improvement activities by Plan-Do Study-Act [PDSA] cycles, to achieve designated goals, guiding the improvement of the quality and efficiency of UFHC services, access to healthcare services with emphasis on performance goals for value-based revenue and performance guidelines. HIM Manager will supervise the HIM Department including but not limited to Medical Records Specialist, Quality Improvement Associate and other staff as needed and will monitor and audit Patients charts and assist in any training or correction in the medical records process to maintain HIPPA Compliance.
Essential Roles and ResponsibilitiesActivities include but are not limited to the following:- Monitor, audit patient chart data to evaluate the UFHC performance in quality improvement, with duties included but not limited to:
- Work with Director of Quality/Compliance/Risk Management to assist with analysis of data related to the quality improvement (QA) program;
- Creating process to capture documentation for QI/HEDIS, Value Based Payment, payer Incentive programs and Assist with PCMH Certification to enhance reimbursement.
- Participate in developing and implementing interventions, and workflows;
- Evaluate and assist in reporting compliance rates for Quality Measures, Value based Payment on a quarterly basis;
- Evaluates medical records chart maintenance, documentation to optimize reimbursement by ensuring that and documentation are monitored to ensure accurately reflects and supports outpatient visits and to ensure that data complies with legal standards and Universal Data Systems (UDS) guidelines.
- Audit and assist with monitoring third party vendor compliance with UFHC quality standards and workflows on a continual basis and report to the QA/QI Committee Monthly.
- Determine adherence to performance measures standards by monitoring performance improvement activities by Plan-Do-Study-Act [PDSA] Cycles and provide guidance that can be utilized to achieve or improve performance.
- Assist in the maintenance and compliance to Patient Centered Medical Home (PCMH) standards of performance and provide guidance that can be utilized to achieve or improve performance through review of documentation or coding issues for review by management and/or professional evaluation committees.
- Act as a liaison with organizations as required improving UFHC utilization of the EMR and compliance with industry standards.
- Makes recommendations for changes in policies and procedures. Develops and updates procedures manuals to maintain standards and maintain knowledge of Regulator Guidelines and practice changes to allow for accurate reporting of measures and to minimize the risk of fraud and abuse, and to optimize revenue recovery.
- Collaborate with the Director of Quality/Compliance/Risk Management to ensure any service of process/summons that the health center or its provider(s) receives relating to any alleged claim or complaint is promptly sent to the HHS, Office of the General Counsel, General Law Division, per the Claims Management Policy.
- Provides technical guidance to physicians and other staff in identifying and resolving issues or errors such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, and/or codes that do not conform to approved coding principles/guidelines.
- Reads bulletins, newsletters, and periodicals and attends workshops to stay abreast of issues, trends, and changes in laws and regulations governing medical record coding and documentation.
- Preform audits in coding and clinical documentation and referral completion to provide feedback in a timely basis as to which measures and/or processes are falling out of compliance.
- Educate clinicians and departments on quality measure expectations and the importance of reporting standards and the impact on reimbursement Serves as a resource for Physicians in documentation improvement practices to measure and improve accuracy.
- Identifies training needs, prepares training materials, and conducts training for physicians and support staff to improve skills in the collection of quality health data.
- Maintain Supervisory role of All HIM, Quality Staff including but not limited to Medical Records Specialist, Quality Improvement Associate, and other staff as needed. Will also monitor HIM Directed Third party Vendors services for compliance to UFHC quality standards on a monthly basis.
- Work in conjunction with the Director or Quality/Compliance/Risk management to monitor, maintain and develop Risk Management, Compliance and Quality regulations and required guidelines.
- QUALIFICATIONS/EDUCATION/EXPERIENCE
- Associates Degree and/or experience related to computer programs associated with data management.
- Current HIM or Coding Certification (AAPC, AHMIA or another national agency)
- Working Knowledge of PCMH and HEDIS reporting; and proficiency in the use of Window Based PC system and a range of software packages, including Microsoft Outlook.
- Ability to evaluate medical records and other health care data;
- Ability to interact effectively with people and perform as part of a team.
- Demonstrated organizational, written communication and oral communication skills.
- Attention to detail and excellent follow through
- Ability to manage multiple tasks simultaneously
- Demonstrated flexibility and problem-solving skills.
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