Community Memorial Healthcare

• Reviews, analyzes, and verifies accuracy of CDM, fee schedules, and associated master files. Performs, documents, and communicates annual/interim price adjustments. • Assists the Director of Revenue Integrity with driving charge capture and revenue reconciliation at the department level to ensure all charges are being captured. • Promotes and implements common statistics and productivity units accumulated via charge master services, common billing codes for similar services, common revenue billing requirements for managed care contracts, and common strategic pricing and mark-up formulas for selected facilities/programs. • Ensures CDM updates occur on a regular basis, synchronize financial systems with CDM maintenance vendor tool monthly, scripts work smoothly, new users are trained, and regular communication with CDM maintenance vendor support with issues and suggestions to continue to enhance the product. • Provides assistance, investigation, research, interpretations, education, reference material, documentation, and policies for CDM-related and Compliance issues/questions to internal and external partners. • Interfaces with and provides education and training to clinical staff to improve charging process. • Performs periodic reviews of each CDM to inactivate or zero-out obsolete, inactive, and non-billable charge codes.

• Responsible for security architecture, engineering design decisions, and enterprise risk mitigation strategies to support the Cottage Health Information Security program. • Designing, developing, configuring, and implementing security solutions. • Guides and leads the tactical implementation of relevant security initiatives and services. • Areas of responsibility include security architecture, firewalls, monitoring and response, endpoint security, vulnerability management, security incident response, and forensics. • Supports the Information Security Team in performing security assessments, product evaluations, project support, and any other operational tasks needed to support the Information Security program and strategic objectives.

• Developing, implementing and managing Security Governance, Risk and Compliance programs • Identify and mitigate security risks • Work directly with the team manager • Focus on specific areas like IT and Security policy management or auditing

• Managing a variety of large scale project portfolios that fall within the technical and non-technical areas from concept through deployment. • Works collaboratively with senior leadership, IT groups, business partners, suppliers and other teams to consistently deliver portfolios on time, within scope and within budget.

• Supervising the Threat Management and Security Operations teams. • Ensuring secure, efficient operations within these technical areas.

• Supervising the Governance, Risk & Compliance (GRC) and Identity & Access Management (IAM) functions. • Managing technical teams ensuring compliance of the GRC and IAM areas to ensure secure, efficient operations.

• Manage large scale project portfolios within the technical computing infrastructure • Collaborate with senior leadership, IT groups, and business partners • Ensure portfolios are delivered on time, within scope and budget

• Codes and abstracts inpatient and outpatient conditions, diseases, and procedures according to coding guidelines. • Assigns appropriate DRG/APC classifications. • Collaborates with clinicians and CDI staff to obtain necessary documentation. • Assists with internal coding audit and training activities.

• Manages the CDI staff: Management of daily activities of the Clinical Documentation Specialist (CDS) team: schedules staff; provides work direction and training/mentoring; ensures timely completion of assignments and performance evaluations. • Validates and improves quality of query activities; provides feedback to the director on operational concerns; provides feedback to Physician Advisors on provider response issues; assists with physician in-services as needed. • Reviews and analyzes data and reports to evaluate progress and helps initiate process improvements. Reports updates and team progress to appropriate committees. • Works closely with the Coding and CDI staff to resolve discrepancies between working and final DRGs, and coordinates efforts with coding/HIM/UR and other departments to ensure the coded record reflects the acuity of patients and level of provider care. • Develops and implements on-going CDI nurse and physician education and training programs to solve coding and documentation issues. • Acts as leadership resource for the team; supporting, fostering and assuring the continued professional development of group/individual skill sets and competencies. • Assists with departmental budget annually as requested by QI Director

• Codes and abstracts diseases, procedures from the medical record according to ICD-CM and CPT classification systems • Participates in quality improvement activities by identifying specific cases and pertinent data as requested • Completes and monitors follow up activities, complete documentation, MD Query responses, claim and DNB edits, daily • Communicates with physicians concerning incomplete documentation and clarification of diagnoses/procedures utilizing appropriate facility query process • Validates coding to assure proper APC assignment