Why work for Nebraska Methodist Health System?
At Nebraska Methodist Health System, we focus on providing exceptional care to the communities we serve and people we employ. We call it The Meaning of Care – a culture that has and will continue to set us apart. It’s helping families grow by making each delivery special, conveying a difficult diagnosis with a compassionate touch, going above and beyond for a patient’s needs, or giving a high five when a patient beats a disease or conquers a personal health challenge. We offer competitive pay, excellent benefits and a great work environment where all employees are valued! Most importantly, our employees are part of a team that makes a real difference in the communities we live and work in.
Job Summary:
Location: Methodist Corporate OfficeResponsibilities:
Directs coding for Nebraska Methodist Hospitals and hospital-based outpatient clinics (System Wide) (35%)
Manages internal and external coding resources to ensure the timely, accurate, and compliant assignment of diagnoses and procedures, supporting appropriate severity of illness and intensity of service capture.
Oversees concurrent coding activities in partnership with the Clinical Documentation Improvement (CDI) team to enhance documentation accuracy and optimize reimbursement.
Directs the administration, maintenance, and optimization of coding software, encoders, computer-assisted coding (CAC) tools, and related system applications.
Establishes and monitors coding quality and productivity standards, ensuring staff performance meets or exceeds organizational expectations.
Ensures coding compliance through ongoing monitoring, education, and periodic internal and external audits, implementing corrective actions as needed.
Leverages advanced coding technologies and automation tools to improve coding accuracy, completeness, efficiency, and regulatory compliance.
Oversees the full lifecycle of Recovery Audit Contractor (RAC) and Targeted Probe and Educate (TPE) audits, including audit tracking, documentation collection, response preparation, coordination with clinical and revenue cycle teams, appeal support, and adherence to CMS requirements and submission deadlines.
Clinical Documentation Improvement (CDI) (20%)
Provides leadership and oversight of the Clinical Documentation Improvement (CDI) program, ensuring completion of daily concurrent and follow-up reviews, timely physician query resolution, ongoing provider education, and collaboration with coding staff to support accurate DRG assignment and reimbursement.
Builds and maintains a high-performing CDI team capable of effectively engaging physicians and other clinical practitioners to improve documentation quality and accuracy.
Develops and delivers physician education initiatives to ensure clinical documentation accurately reflects patient acuity, severity of illness, risk of mortality, quality outcomes, and resource utilization.
Oversees staff training, competency development, quality assurance reviews, and onboarding/orientation programs for new physicians and clinical practitioners related to documentation and coding best practices.
Champions industry best practices in clinical documentation integrity, promoting accurate and complete capture of patient care that supports compliant coding, quality reporting, and reimbursement outcomes.
Analyzes and monitors key performance indicators, including case mix index (CMI), severity of illness (SOI), risk of mortality (ROM), and CC/MCC capture rates, identifying trends and opportunities for targeted physician and coder education and process improvement.
Oversees Utilization Management for hospitals (20%)
Provides leadership and oversight of utilization management processes to ensure timely acquisition and extension of payer authorizations, supporting appropriate reimbursement and continuity of care.
Collaborates with commercial, government, and other third-party payers to facilitate authorization approvals, resolve coverage issues, and ensure compliance with payer requirements.
Oversees the provision of clinical review information that accurately reflects the patient's condition, treatment plan, level of care, and medical necessity to support authorization and reimbursement decisions.
Partners with clinical, case management, and revenue cycle teams to optimize utilization review practices, minimize authorization denials, and improve financial and operational outcomes.
Supports management of the Methodist Cancer Registry (5%)
Provides oversight for the implementation, maintenance, and optimization of the enterprise-wide, multi-facility cancer registry database, ensuring data integrity, standardization, and regulatory compliance across all entities.
Ensures compliance with accreditation standards established by applicable cancer program accrediting bodies, provides accurate and timely data to cancer committees, and supports educational initiatives related to oncology data management and quality improvement.
Directs the collection, abstraction, validation, and submission of cancer data for all eligible cases in accordance with state, national, and regulatory reporting requirements, ensuring completeness, accuracy, and timeliness of submissions to cancer registries and other required agencies.
Schedule:
Full time
Job Description:
Education
Requires Bachelor's degree in Nursing, Health Information Management or Healthcare related field.
Master's degree preferred.
Experience
Minimum of 7-10 years progressive experience in hospital/health care setting.
Minimum of 10 years of management experience.
Recent experience in a hospital, health system or large multi-specialty physician group setting.
Demonstrated track record of mentoring teams resulting in higher level of job satisfaction and performance.
Minimum 5 years' experience managing different components of the Revenue Cycle preferred.
License/Certifications
Current valid Registered Nurse (RN) license, valid compact multistate license, or a temporary permit while awaiting licensure required.
Or
Certified as a Registered Health Information Administrator (RHIA) required.
Skills/Knowledge/Abilities
Knowledge of rules and regulations regarding registration, the legal medical record and release of information.
Proficient DRG, ICD-10, CPT-4 medical record coding, UB04/CMS-1500 claim billing.
Knowledge of revenue cycle accounting concepts.
Proficiency in Health Information Systems, coding technology, and various other system applications related to coding and clinical documentation.
Ability to work independently.
Ability to effectively manage uncertainty and complex situations.
Ability to motivate a high performing team.
Demonstrates a sense of urgency.
Ability to identify, analyze and effectively address complex issues.
Ability to establish positive working relationship with a variety of departments/individuals and promote collaboration. Position requires a strong positive working relationship with medical staff.
Weight Demands
Light Work - Exerting up to 20 pounds of force.
Physical Activity
Not necessary for the position (0%):
Balancing
Carrying
Climbing
Crawling
Crouching
Kneeling
Lifting
Pulling/Pushing
Standing
Stooping/bending
Twisting
Occasionally Performed (1%-33%):
Distinguish colors
Grasping
Walking
Frequently Performed (34%-66%):
Keyboarding/typing
Reaching
Repetitive Motions
Sitting
Speaking/talking
Constantly Performed (67%-100%):
Hearing
Seeing/Visual
Job Hazards
Not Related:
Chemical agents (Toxic, Corrosive, Flammable, Latex)
Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF)
Physical hazards (noise, temperature, lighting, wet floors, outdoors, sharps) (more than ordinary office environment)
Equipment/Machinery/Tools
Explosives (pressurized gas)
Electrical Shock/Static
Radiation Alpha, Beta and Gamma (particles such as X-ray, Cat Scan, Gamma Knife, etc)
Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that causes injuries to tissue or thermal or photochemical means)
Mechanical moving parts/vibrations
About Methodist:
Nebraska Methodist Health System is made up of four hospitals in Nebraska and southwest Iowa, more than 30 clinic locations, a nursing and allied health college, and a medical supply distributorship and central laundry facility. From the day Methodist Hospital was chartered in 1891, service to our communities has been a top priority. Financial assistance, health education, outreach to our diverse communities and populations, and other community benefit activities have always been central to our mission.
Nebraska Methodist Health System is an Affirmative Action/Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation, gender identity, or any other classification protected by Federal, state or local law.