Saturday, July 11, 2009

Coding Manager Handbook -- Chapter 1: Managing the department

* Managing the Department
* Goal Setting for Managers & Supervisors
* Delegation of Workflow
* Project Management
* Communication with Senior Management
* Employee Performance Evaluations and Reviews

Chapter 1: Managing the department
As a first time coding department manager, you have probably now realized that managing a department of coders requires many different organizational and human resource skills sets – or as I like to say “You get to be the “Jack/Jill of all trades”. In your department, you will find that most coders are: highly organized, detail oriented, efficient, curious, willing to research, ask questions, be flexible, are goal oriented, and have the ability to manage workload, time constraints , plus, get along with the unique and varied personalities within the department. Included in your department may be personnel that perform secretarial services , data entry functions of charge and payment input, medical transcription, claims billing and appeals/audits for 3rd party payros, oversee the computer/IT sending of electronic claim data, and electronic health/medical records (including privacy and security,) and you may even have staff that do credentialing of physicans for 3rd party payors, and state/federal licensure, and coding compliance

Of course, you as the manager/supervisor of the coding department need the same skills as your coders and ancillary staff, but also be a mentor, counselor, friend, critic, project manager, negotiator, and “department cheerleader” to promote coding department success.

On top of all that……you need to have additional skills in budget management, human resources, time management, meeting management, physician recruitment/retention/education + their needs (and wants), audit and analysis skills for 3rd party payor contracts, coding proficiency, compliance, HIPAA, JCAHO, ensuring privacy and security of the billing/medical records, and most of all…. The ability to pull it all off with a smile!


First time managers for a coding department face multiple issues. A priority for the coding manager is to have a firm grasp of the goal setting process. A coding manager needs to be able to set appropriate goals for themselves as a manager, goals for the coding department, help set goals for your coding team members personal goals within the department, , and to help your employees also look at these goals and how all of this is interconnected within the office or hospital where they work.

To be an effective manager/supervisor, you need to understand the basics of goal setting for yourself, and your team. As with any management-type job, it is well known that staff respond positively when they have a good manager/management staff in place. As a manager you must continually work on your own personal and professional growth as a manager.

Goal setting can be defined as accountability to an idea or concept followed through to completion. In addition to goal setting, you have to have a firm vision of your goal, and be able to engender trust and viability in your goal, allowing your employees to “buy in” to those goals and make them a reality. You can set the goal by yourself, but it will take the entire “department”, “Team”, or “organization” working together to make it a reality. When setting your goals keep these things in mind..
 Set your goal(s) to be realistic and attainable, but needs to be specific.
 Your goals should contribute something to the organization, such as to improve revenue flow, morale, streamline specific processes etc..
 All team-members must be involved in the process of the goal-setting, and have “buy-in” to the process and to the final outcome. Bring in not only the staff you oversee as a manager, but also, bring the buy-in of upper management, and other departments that may be affected too.

In researching the best methodology for your goal setting for the department, there are multiple “plans” available for a manager to choose from. I have found that most new-managers lack a formal “process” to help them achieve these goals. Below is a set-by-step process to help the new manager get a firm grasp of how this needs to happen.
1. Create a vision of your goal, express the desire to achieve it and WRITE IT DOWN. By writing down the goal, this give the goal “life”. Be sure to have it posted someplace where all team-members can see it , be motivated by it, , and involved it the process of meeting (or exceeding) the goal and how to get there.
2. Identify the obstacles to achieving this goal (i.e. not enough staff, erratic revenue flow, poor morale etc). Once those obstacles are identified, evaluate how to overcome those obstacles.
3. Set a deadline for the achievement! Analyze and implement the time needed to reasonably achieve the goal for the department, yet be flexible in the dates if needed
4. Set the plan in motion. List and prioritize the activities, personnel, and others that need to play into the goal for achievement of success. Outline consequences of failures. Be aware that many times failure brings an incredible learning opportunity and wealth of unexpected education in your goal processes.
5. Do the 4 “f”’s Feedback, Follow through, Follow-up, Flexibility. Be sure to encompass these activities in relation to the plans outlined in #4. Make adjustments, be persistent and resolute in your progress toward your goal. If you have setbacks, or failures, again, as above, evaluate what went wrong, learn from the mistake, and move forward.
6. CELEBRATE ALL SUCCESSES – no matter how small.

Workplace interruptions – a setback for goal successes.
Issues that go hand-in hand for first time managers is the issue of time-management within the goal setting processes. Interruptions can be a hindrance to your management of the coding department, however, interruptions can be a necessary “evil”. An open-door policy with your staff creates a very warm and caring environment, but you will have occasions that you feel you did not accomplish anything, as you were constantly interrupted the entire day. Interruptions to your workday not only adds stress to your job, but also can be a hidden “problem” that is not readily acknowledged in goal successes or failures. New managers may want to look at implementing some ideas to reduce the number of and the impact of minor interruptions.

Phone calls both internal and external are a common source of interruption. One of the easiest things to do is schedule specific timeframes for taking/returning calls, responding to voice mail, checking e-mail, receiving visitors both internal and external. Be flexible in your adherence to scheduling these types of activities, as there are always times when “emergencies” arise, and you need to take care of them immediately. My favorite analogy to this is “just because someone throws you the ball, doesn’t mean you have to catch it1”

As the first-time manager, this gives you the perfect opportunity to train the staff around you to respect your schedule (and theirs). This means you must also have the self-discipline to follow through in the same manner with others.

Another “time-stealer” in your day is interruptions that could be taken care of by the employee. Employees need to have clear direction where to find answers. Having ready access to policies and procedures, work forms, job tools, coding manuals, will also reduce interruptions to your day. If the employees know where to find the tools, and how to use them – encourage them to do so.

Allow your employees to “take ownership” of an issue. Make sure that they all understand their level of authority to make decisions. Give them permission to make those decisions within their scope of authority. Encourage and educate our staff to use sound judgement, and rely on the company’s policies and procedures without fear of repercussion from you as their manager. In the case of a poor decision, or judgement, assess the issue, learn from the experience, and move forward.

Keep an open line of communication!. Staff love to have face-to-face time with their managers especially when it can be done as a daily part of your day. Make time each day to say “hello” to your staff, get to know them. Ask how things are going etc.. If they say things are “terrible” – then schedule a time to talk with them one-to-one. If they say “great” encourage them, SMILE, and say “thank you, that is good to hear”. The more positives you can send out the better you are.

You will always have interruptions, but by managing these time-stealers, you will then be able to spend more “productive” time, rather than feeling stressed about the interruptions.

Developing clinical knowledge needed for the position
As a first time coding manager, you will most likely have staff that are far better at coding than you are. However, you have been tapped to be the coding manager, most likely because you hold other skills necessary to be a manager rather than a “worker bee”.

In developing your clinical knowledge, express to your staff that you realize that they are the “experts” at what they do, and that you will rely on them and their expertise regarding coding, and conding convention. However, this does not absolve ;you of the education process.

At the bare minimum, you should be a certified coder of some type. There are many different types of accreditation. The American Health Information Management Association (AHIMA) supports education, and supplies credentialing criteria for medical records oversight, hospital and physician based billing and coding, compliance, privacy, security and data management. The American Association of Procedural Coders (AAPC) provides credentials for hospital based and physician based billing and coding, in addition to specialty credentials for physician based billing.

In addition to learning how to code CPT, ICD-9 (diagnostics and procedures)and HCPCS, a good coding manager should also have a firm grasp of Anatomy and Physiology, Disease progression and management, Medical Terminology, Laboratory and Pathology tests/procedures, Radiology procedures. They also should round out their clinical knowledge with valid computer skills.

As a manager, take the time to educate yourself in addition to educating your staff. Make a commitment to education and the education process. Successful coding managers meet face to face with their staff at a minimum once per week. Make that time very productive, utilize an “educational roundtable’ format. Save up items during the week to bring to the forum, as the staff to do the same. Distribute and disseminate all education at the roundtable. Give an opportunity for questions and answers, be willing to utilize all forms of communication during the week, if the “formal” meeting process gets cancelled or interrupted.

Major coding and policy changes should all be noted in writing and held in a policy/procedure type book. This can be via electronic format or “old-school” paper format. Make sure that you and all of your staff have access to the most current ICD-9, CPT and HCPCS books available. Make your education roundtables “fun”. Utilize puzzles, games, speakers, webinars, audio-conferences, and incentives such as “lunch with the boss”, or gift certificates for those that participate. Develop a quarterly “test with the best” type quiz format for all coders to do, and place in their personnel files. As the manager, encourage outside departments to participate in these educational roundtables for your staff and encourage “sharing the knowledge” of what they do in their area of expertise, and how it impacts what you do in the coding/billing departments.

As a coding manager, don’t be afraid to ask questions of your physicians, or clinical providers. The more education you have, the better manager you will be. Don’t be afraid to share the knowledge. Encourage your coding “experts” to share their knowledge. In the long-run, this “sharing of the knowledge” enhances morale, and communication between the “clinical staff” such as , physicians, nurses, lab techs, x-ray techs, and medical assistant with those “non-clinical” personnel such as your coding/billing staff, medical secretaries, transcriptionists, customer service and collection personnel.

Delegation of workflow
Delegation is an essential part of any manager’s job, but is crucial for a new manager. As a new manager implementation of delegation sets the stage for how your employees view you as the manager, and what they can expect from you as a manager.
Employees like to have work delegated to them. Delegation can be a good process to discover hidden employee talents. In addition, it gives the employee the opportunity to “show their stuff” and really contribute to the organization. Another benefit of delegation, is this also helps to increase job satisfaction, morale, and provides recognition for those employees who succeed in completing those delegated tasks. Properly delegated job tasks not only make your employees look good, it makes you look good, as you effectively delegated the workflow, and had a positive outcome for everyone.
There are many benefits to delegation, as it can save time, motivate staff and teams, develop your employee’s personal growth and confidence, in addition to your own growth and confidence. Successful managers are ones who can delegate effectively, and keep from getting mired in the “I can do it all myself” mentality.
eld within that “I can do it all myself” mentality, I’ve listed below some of the “reasons” managers won’t delegate. These are the areas that you want to avoid at all costs… I am a firm believer that if you can learn from other’s mistakes, take the time to realize what the education value is from that mistake, and not to repeat it yourself. Try to keep from sailing in the “fail boat”.

A. Do not trust employees with responsibility
B. Only we (as managers) know best
C. I can work faster on my own
D. I don’t want to lose my control….
E. I don’t want to lose my authority…
F. I don’t want anyone else having “credit” for what I have done
G. The employees are not committed to the project
H. I won’t be able to keep track of the developments

Delegation of work should be an “offer” not a “demand” set for your employees. Ultimately it is the manager’s responsibility for making sure the work is completed according to the demands of the project, upper management, or corporate policy. As a manager, you can bestow a designated amount of authority to the employee to complete the task or project, but , you are still the one held accountable for completion and follow-through of the tasks.
When delegating tasks, be clear about the fact that you are not trying to “shove off” a particular job onto your employees. Clearly define that this is a “sharing” of the responsibility. You as the manager, will need to maintain communication with all who are involved throughout the life of the project. All success and failure will fall upon you as a “collective” not as a singled out entity to “take the fall”. As the manager, you should put yourself out front to take the heat for their “learning curve”, and be sure to re-educate the staff, and put the project back on task. Failure is a isk, and it does happen. Don’t fear your failure, face it, learn from it, and move forward.
A. Set the context of what is being delegated. Let your staff know WHY this project is important, and how it is good for them, for you, and the “team goals”.
B. Negotiate the delegation – make sure you have the authority, and resources to make this happen.
C. Assess the skills of your staff, then delegate the tasks to the most appropriately skilled individuals.
D. Remember that the ultimate responsibility of job/task delegation lies with you as the manager.
E. Communicate regularly and effectively back to those being delegated to. This allows for change or adaptation of the workflow if needed.
F. Accept the risks, be flexible, and set the standard that you “know” your employees will succeed and do well. – Risk involves Success, Failure, or both!
G. If you succeed – celebrate, If you fail, accecpt the failure, learn from it, and move forward.

Project management is a critical part of a coding manager’s job. Keeping all players on-task is sometimes overwhelming. One question that employees sometimes asked is “what do project managers really do?” and “why do we need a project manager?”. The popular notion out there, is that a project manager is “unnecessary overhead, a person that does nothing except schedule meetings, “outside manager that nags people to get their work done, or someone who was sent by management to “spy” on the employees. Nothing could be further from the truth.
The definition of a good project manager can be described as “the person who performs the , detail planning, organizing, budgeting, and management of resources needed to bring successful completion to a specific job, project, goal, or objective. The role of the project manager is varied, but the area of the most concern is the rapidly changing environment(s), the communication between the parties, and stakeholders. In addition, coordinating the functions and skill sets needed for the project, then bringing the players and stakeholders on-board, providing the work-flow schedule, keeping all on task, on time, and keeping the communication between management and the “worker bees” flowing smoothly.
Project management requires a varied and diverse skill set, that not everyone embodies. The first two critical areas require a coding manager to have “technical skills” which can be learned through training, but you also need to have the “people skills” or “human behavior sets” to go with the core set of technical skills. The technical sklls needed for a project manager, is the ability to plan projects, assess the project status, and identify areas and issues related to risk factors. These skills can be learned by the coding manager through various methodologies, such as classes, seminar’s, on-line, book references etc... However, the “people skills: are much more critical to the success of the project, and much less clear-cut when assigning and taking on the role of the project manager. These “people skills” require someone who has the capacity to anticipate problems or issues, have a good attention to detail, and in essence be a “good sales-person”, or embody the ability to persuade others. The innate ability to think ahead of the curve, and anticipate problems or issues, be able to focus on both “big picture and small-scale” details, and influence or “sell” the project plan can really add value to the project manager.
The most critical piece of all is the ability to communicate well with ALL parties. All need to be kept in the loop of the project progress, management expectations, successes and failures. Good project managers should be chosen first on their “people skills”, then teach the “technical skills”.
Once your have chosen your project manager, or if you are the project manager, you now need to deal with the “how to do it” factor. There are 4 basic elements to a project: Resources, Time, Money and Scope. The resources you need will be a) people/employees to perform the job, b) the equipment, and/or tools and c) the material(s) tangible or intangible for the project. The time elements to be considered are a) the tasks at hand and the duration needed for completion, b) the dependencies upon internal and external contractors or providers for delivery of goods/services and c) the critical pathway determined for the timeline. The money element has to be managed with a)costs internal and external, b)contingency plan if over/under budget, and c) profit/loss within the project plan. And last is the scope of the project. Within the scope, you need to know the project size, the goals, and the requirements of the total project involvement.
Most project managers assume that the most important issues are the people, time and money elements, but really, the “scope of project” is the most important. A good model for the project manager is to define the scope of the project and what you are to accomplish, then review the budget for time and money constraints. It is absolutely imperative that any change to the scope of the project have a matching change in budget, time or resources. Any requested changes, no matter how small, need accompanied by approval for a change in budget, schedule or both. You can not effectively manage resources, time and money in a project unless you actively manage the project scope. When you have the project scope clearly identified and associated to the timeline and budget, you can begin to manage the project resources.
When dealing with the scope of a project, sometimes comes the problem of “scope-creep” I define this as the “piling up” of small changes that in themselves are manageable, but when multiplied, or numerous the “manageable” now has become “monstrous”. Scope creep is fairly common, within a project, but a good project manager is aware of it, and handles it as it appears.

Project Management Approaches
There are several different models for project managements. Outlined below are some of the different types and styles of project management approach. This is just a very quick overview, but you may want to review each of these styles in depth prior to the initition of your project. Each brings a different type of management to the project, so I cannot recomment one model over another.
 The traditional Approach or Model: This project management approach/style embodies a sequence of steps to be completed. i.e.
o Initiation
o Planning/Design
o Execution/Projection
o Monitoring and controlling
o Project completion/termination
 Critial Chain Project Management (CCPM): This is a methodology that puts more emphasis on needed resources to complete the task. The ultimate goal of this type of project management is to increase the rate or speed of the completion of the project. Tasks are given the ultimate priority over all other activities, Projects can be staggered based upon the resources available to complete the identified tasks.
 Extreme Project Management (XPM): Extreme Project Management works well for the large- or small scale, one-time, non-routine project. XPM is very successful for quick “down and dirty” projects that have simple task(s) outlines, within quick, manageable timeframes. XPM is not meant for multi-project, or long-term, detailed projects.
 Event Chain Methodlogy: This is best described as an analysis management technique that is focused on identifying and managing events and event chains that affect the project schedules. This method allows for the handling of uncertainties in the project schedules and is based upon these possibilities:
o Probabilities of risk, and external events affecting tasks and task planning
o Event Chains Analysis – i.e. events causing other events… by using analysis to contain or minimize the event chain progression,. Eliciting “paradigm shift” thinking or encouraging “critical event chain” pro’s and cons for “show-stopper” events
o Project tracking to enhance communication and distribute data about the project to all players
o Usage of charts, graphs, or diagrams for “event chain” visualization.
 Prince 2 process model: This is a very structured approach for generic project management. This method has a clearly defined framework, divided in manageable stages. It also provides an efficient way to control resources, by strictly focusing on the framework, and closely monitoring a project in a controlled and organized process. Within this management process, specific goals and activities are carried out within very structured and narrow pathways. This process can be misconstrued by some as “micro-management” of the project. It is a very successful project management application for projects that have tight budgetary and cost containment elements.
 Process based Management: This project management style can best be described a the “human collaboration”. This uses the “human element” to perform projects that are task based, conceived and executed as the situation demands (on the fly) rather than as a pre-planned process. As a coding manager, this is going to be the majority of your projects that fall into your scope.
 Rational Unified Process (RUP): this process development was created by IBM and utilizes a “project team” approach. This approach divides up the project amongst a defined set of “team players” to carry out the phases of the project. These phases are noted as
o Inception – identifying the initial scope of the project
o Elaboration – providing a full description of the project and it’s flow
o Construction – putting the teams together, and dividing up the workflow,
o Transition – validating and deploying the “project team/work teams”
o Completion – show enhanced qualifiers for success/failure that are project specific
 Color Coding Design project management: This type of management quickly shows “where” the project is in relation to a specified color management scale. This gives information to managers and or executives quickly and concisely without a lot of explanation. This type of project management is similar to what the government has put in place for the forest service fire danger levels.
o Green = minimal fire danger risk, campfires allowed, no restrictions
o Yellow = moderate fire danger risk – campfires allowed only within approved fire ring or fire it.
o Red = High fire danger risk - no campfires allowed,
This type of project management translates well, and is easily updated on a day to day, week to week schedule, and the indicators can be as sophisticated as you would like to get. Also, this can be modified so that if you want to put this type of communication out electronically, it can also include the “detailed” reports via a hyperlink.

Regardless of which type of project management style that you choose, the bottom line to any project management endeavor is
1. Communication
2. Coordination
3. Completion
4. Celebration!

As a new manager, you will need to have ongoing communication with your upper management, in addition to your employees. As we all know, the better the communication back and forth, trust is built between both parties. You will need to work with your senior management to decide what type of communication style works best for both of you, then decide how often, how much etc..
The basics of communication is always the – “who”, “what”, “when”, “where”, and “how”. It just depends on the issues at hand, as to which of the above will need to be answered, or queried. Most upper management does not like change, so a set schedule for 1-1 meeting(s) or face to face meeting(s) is usually best. When it comes to meeting with your upper management be sure to communicate effectively for their buy-in, respect their position within the organization, and remember that patience from you is essential. They may be in a hurry, but you need to embody a patient persona, so you don’t appear, rushed, harried, confused, or ill-prepared when you meet with management. Do not allow your personal life to interfere with your “work-life” Maintain a positive “can-do” attitude. Present yourself as a problem-solver, not a problem creator. Don’t criticize, be a good listener and a positive role-model. Be willing to adapt to change, and be optimistic about whatever changes are being proposed. If you do not agree with the proposed changes, be willing to share your ideas but be open to change, and embody a feeling of trust and leadership. Be dedicated to doing what is best for the organization, not just for your department, or yourself. Look at both the “big picture” and the “short-term” areas that may be affected.
When meeting with your upper management, you are now wearing the “employee” role, rather than the “manager” role. As an employee, you need to do your best to share your ideas and processes with your upper management. You need to include both your successes and failures. However, always begin with a success, explain a failure, and then show how that failure became a learning experience, and end with a success. Make sure that you state the impact of the problem or failures in business terms, and avoid emotional involvement when explaining the issue. Clearly define what the problem is/was, and how you have fixed, or are fixing the issue for resolution. Again, avoid emotional involvement, and try not to come across as “complaining” about the difficulty of the issue.
Many times, with the busy schedule of your executive management team, scheduled face-to-face diaglogue may not happen, or gets re-scheduled. You may need to find alternative ways to update and communicate with upper management. Be creative, as sometimes you only have a short amount of time to get across important issues. I’ve listed below some of the creative ways to “meet” and have the “ear” of important upper managers.
 Walk with the upper manager(s) as they are going to another meeting(s)
 In the hallway
 On an elevator
 On the telephone via voice mail
 Cel phone messages
 Text Messages via a Cel phone
 E-mail, or Instant messaging via the computer
 Newsletters
 Formal reports or meetings
 Memo’s
 Quick reports or “stat sheets” with graphs/photos to explain your issues
 Meet for lunch, breakfast, coffee break, afternoon break
 Regularly scheduled face-to-face time (ie weeky, monthly etcc)

Learning to communicate with upper management may be overwhelming, and daunting, however, by communicating successfully you will reap the rewards with on-going trust of what you can do for the organization,byr upper management. In addition, you will gain more confidence in your communication skills within all levels of executives throughout the organization.
Do your homework regarding the organization. You need to know the background, the current issues, and the future goals of the organization, prior to meeting with your upper management. They may or may not provide you this information, so be prepared to find it out yourself.
 Understand the mission of your department, and how it interrelates within the scope of the organization.
 Get to know the other staff, and department managers. Build inter-relationships with those departments, managers and staff so you can work together seamlessly and as team-members not adversaries.
 Be open to the views of those outside of your department.
 Understand the organizational authority and the chain of command. Determine where your place is in the management hierarchy.
 Explore and understand where your coding department is in relation to historical events, staffing, budgets, growth/shrinkage and economic challenges of your department within the organization.
 Know the layout of the facility. Know where ancillary departments are located, where are the closest elevators, where is the employee parking, cafeteria etc…
 Know how to get ahold of your upper manager/management in time of crisis, or who is “second” in command, if your manager/supervisor/executive is out of the office.
Once you have done your due diligence and have a good firm grasp of the basics above, you need to set the stage and find out what are management’s expectations are for you…By asking these questions opens the door to communication and addresses “known” issues up front, and hopefully avoids mis-communication in the future.
 Internal and External Customer Service processes
o Telephone and computer protocols
o Privacy and Security protocols
o Release of Information (both medical records, medical billing, demographic databases)
o Human Relations – hiring/firing protocols for managers and employees
o Interdepartmental relationships – Physician and Medical Staff expectations.
 Risk Management
o Who has, had, will have access to the medical records (hard copy and electronic)
o Computer access – Internet protocol, VPN’s, outsourced transcription services
o “red-flagged” charts for court cases, and federally protected medical information for high-risk diagnoses such as HIV/SARS etc..
o Hazardous spills, blood borne pathogen exposure, fire safety, crisis management (i.e. stolen baby, missing patient, adverse patient event)
 Budgetary Processes
o Correct coding for services rendered – vs/coding for reimbursement/upcoding?
o Certified Coders vs/non-certified coders and the job functions and descriptions
o Staffing: Full Time Employee’s vs/ Part Time Employees
o Salaries and organizational employee benefit costs (i.e. health insurance, 401K etc)
o Cost of supplies /work-tools (i.e. software, coding books, encoders, computers, fax’s etc)
o Cost of on-going employee, management, and physician education (both in-house, and outsourced)

Unless you have made other arrangement with upper management regarding communication, a quarterly report on the progress of your department is a welcome touch. In addition to reporting on your progress, include a brief summary of what you or your department has done that has had a direct impact on the organization. Include information such as if you have saved time, money ancillary resources, process improvements, or if you have taken on additional responsibilities, or made positive impact upon the areas above. (Budgetary process, Risk Management, or Internal/External customer service processes)
There are times, when you may have to take your case directly to the executive committee’s. This is an excellent opportunity to hone your presentation skills. You may need to present your issue/solution to a large audience. If so,
o Present your case so that you can show your proven expertise in the subject matter, but do not be overbearing or conceited.
o Have a thorough understanding of what you are presenting/proposing
o Dress, Speak, and Act professionally during the presentation
o Be open to all questions and ideas
o If you don’t know the answer, - reassure the group and you will find out then FOLLOW-UP.

When communicating with the upper management, be sure to include discussion regarding your professional development within the organization. You should be willing to share your knowledge and expertise, in addition to continue to take advantage of learning opportunities. When attending conferences, follow up to your upper management of what you learned, and how it can benefit you, your department, or the organization. By providing a mini report on your educational activities and emphasizing the benefits will increase the chance for upper management to allow you to participate in these events in the future. Be an active part of your specialty societies such as AHIMA, AAPC, AMA, MGMA. Keep up with changes and trends in the coding industry by taking advantage of internet-based webinar’s, list-serv’s, and participating in carrier based informative seminars. Take the time to network with your peers both within and outside the organization.

In conclusion, communication with upper management is an on-going process, and it takes time, dedication and diligence on a daily basis to make it successful. If you take the time to outline the expectations up front, you will enjoy a positive and successful relationship with your senior management, executive staff and physician providers.


As a new manager, you will have the daunting task of creating job descriptions, and including the essential and non-essential job functions of the position. In addition, you will have to be evaluated, by your supervisors, and in turn, evaluate your employees based upon the job descriptions and job functions that you have created or revised.

The first critical step in this process is performing a job analysis. The job analysis, is a formal process in which specifics about the job is collected, analyzed, and documented. Within this analysis, you need to include the tasks involved, the methods or methodology used to complete the task or job, the responsibilities and who it is responsible to, the purpose of the job, and how it inter-relates to other jobs and personnel within the department, and last (but not least) the personnel qualifications needed to perform the job. Be sure to closely examine the tasks and the sequence of the tasks necessary for the job. Don’t forget to look at the knowledge base, and essential skills needed to perform the job

Most jobs within a department are not “static”, but subject to change. This happens through organizational changes, new technologies, and personnel changes. Keep the job descriptors “flexible” and don’t get “stuck” in the “but we’ve always done it this way” format. Involve your employees in this process to get a feel for what is “truly” going on in the workplace, and be sure to gather as much information as you can about the tasks. What you see as a manager, may not necessarily be the same functions that are being carried out by the employees. Once the analysis is complete, review the analysis with your employees, then modify, add, or delete those functions that do not represent the job itself.

When performing the job analysis, focus on the facts only. Don’t get caught up in “who” is currently performing that job, and “fitting” the job to that person(s). The list below gives an idea of the things to look at when performing the analysis:

 Job duty (a single specific task)
 Knowledge needed for the specific task
 Skills needed (competency) for the specific task
 Ability (behavior assessed for competency)
 Physical Characteristics or attributes (i.e. need min 20/40 visual acuity, ability to lift 10 lbs)
 Educational Experience, or Credentials needed

Once you have completed your analysis of the job functions, then look at what are the “essential” functions verses the “non-essential” functions of the job. This will help you when evaluating job applicants, or current employees who are fulfilling these job tasks. Outlined below are some questions to ask yourself, when detailing these tasks.

How much time is spent doing this function?
What equipment is needed/used? And how frequently?
What are the mental and physical elements of the function?
Can other employees perform this function if necessary?
Would taking this function from the job significantly “change” the job?
What are the consequences if the job is not performed?
Did the previous employee perform this function? If yes, document.. If no, why not??

Now you’re ready to start the process of putting to paper the “job description”. Held within the formal job description is a detailed summary of the major components of the job. These components are comprised of:
 The essential job functions,
 The non-essential job function
 Knowledge and critical skills,
 Physical (and emotional) demands
 Environmental factors
 Explanatory information that may be necessary to clarify duties and/or responsibilities.

Keep in mind that the job description will be your basic outline for hiring, training, and evaluating the employee who is fulfilling the job position. A good, well written job description includes the following:
Job Title
Job Objective and Purpose Statement
List of duties and tasks to be performed
Relationships and role(s) within the organization
Job specifications, standards and requirements
Job Location
Equipment to be used in the functionality of the job
Salary range or Range of pay
…. And other duties as assigned!

I have included many different styles and formats of job descriptions for you to review. Each brings its own merit. You may need to “cut and paste” many of these to really get a job description that works well for you, your supervisor, the HR department, and your employees.
The next major step is to create a good evaluation tool to go hand in hand with your job description and job functions. In creating a good evaluation tool you will want to involve your employees, so that all have had the opportunity to provide input and develop the standards upon which they will be evaluated against. Be sure to hand out the “current” job description, and also provide a “blank” copy to all the employees. Ask them to anonymously or as a team develop what standards they would like to see in the evaluation, then combine yours and theirs together. Then go through the process again until all are satisfied with the final copy.

Evaluation tools also come in many different styles and formats. A generic format should consist of the following areas, and these areas can be added together, or deleted to fit your organization. Again, remember these are very “generic” job evaluation criteria, and would need to be revised for job specificity.
A. Cooperation
1. Willingness to assist coworkers ____
2. Attitude when work needs to be repeated ____
3. Adaptability when schedule must be changed ____
4. Willingness to work extra hours ____
B. Attendance and Punctuality
1. Promptness at the start of the work day ____
2. Attendance record ____
3. Stays as late as necessary (within reason) to complete assignment and/or current activity (not a clock watcher) ____
Days Sick:______
Days Tardy:______
C. Initiative
1. Sees when something needs to be done and does it ____
2. Seeks help when needed ____
3. Demonstrates a "self-starter" attitude ____
4. Helps out to achieve the overall goals of the organization ____
5. Makes practical, workable suggestions for improvements ____
6. Commitment to self-improvement ____
D. Dependability
1. Can be counted on to carry out assignments with careful follow-through and follow-up ____
2. Meets pre-determined targets or deadlines ____
3. Can be counted on to overcome obstacles to meet goals ____
4. Can be counted on to adapt to changes as necessary ____
5. Can be counted on for consistent performance ____
6. Is personally accountable for his/her actions ____
E. Attitude
1. Offers assistance willingly ____
2. Makes a positive contribution to morale ____
3. Shows sensitivity to and consideration for others' feelings ____
4. Accepts constructive criticism positively ____
5. Shows pride in work ____
F. Judgement
1. Demonstrates good judgment in handling routine problems ____
2. Analyzes decisions before implementing them ____
3. Has the ability to work under pressure ____
4. Recognizes deficiencies and seeks help when appropriate ____
G. Specific Job Skills
1. Has appropriate knowledge of _____________ as it relates to his/her specific jobs ____
2. Has appropriate skills in operating _______________ ____
3. Has appropriate skills in working with _______________
4. As new ideas or technologies are introduced, is able to learn and use them appropriately ____

H. Communications (Written or Oral)
1. Keeps Manager, Supervisor and/or coworkers informed of work progress ____
2. Reports necessary information to co-workers ____
3. Keeps and maintains all necessary written information that might be required by a specific assignment ____
I. Productivity
1. Work completion is consistently high ____
2. Can be counted on for overtime or extra ____ effort as needed to meet the organization’s goals ____
3. Makes effective use of resources available to accomplish all assignments, avoiding waste ____
J. Interpersonal Relationships
1. Maintains a positive relationship with the management team ____
2. Maintains a positive relationship with other workers ____
3. Listens effectively ____
4. Is a team player and participates with others to accomplish the task at hand ____
K. Organizational Skills
1. Performs tasks in an organized and efficient manner ____
2. Handles multiple activities simultaneously ____
3. Makes effective use of time (not merely busy) ____
L. Safety
1. Performs activities in a safe manner ____
2. Understands and supports the safety program/policies ____
3. Encourages safety of others on a regular basis; recognizes unsafe working conditions; suggests new safety standards as appropriate ____
M. Miscellaneous Objectives:
1. What creative contributions (new ideas, procedures, etc.) has the employee made in the past year?
2. What new skills has the employee learned or shown improvement in this year?
3. What is the employee's greatest strength or area of contribution this year?
4. Where could there be improvement in the employee over the next year;
5. What specific training should be considered?
6. What changes would the employee like to see in the next year?
7. What are the employee's personal goals for the next year?
Now that you have gotten the evaluation written down, the next step is to meet with the employee face to face. Giving evaluations is a difficult process, as some workers react to this opportunity to meet with their supervisor as a positive step in their career pathway, while others are defensive and resent the fact that they are being evaluated. You want to make sure that the evaluation process is a positive experience, and when you meet for the evaluation, nothing contained within it should be a “surprise” for the employee. You want your employees to understand the criteria for a positive evaluation, and the steps/educational/training processes involved, if the evaluation is less than satisfactory.
This meeting with the employee will be one of the most important that you will have with your employee within the year. Set up your meeting schedule to allow plenty of time to discuss each issue in depth. Let the employee know which areas they are excelling in, and which areas need improvement. Remind yourself, and your employee that no one person is “perfect”, and that we all have strengths and weaknesses, and can improve.
Avoid giving the appearance that some employees are “favored” over other employees. Be objective, specific, honest, and evaluate “performance” not “personality”. There will always be employees who are more “in-synch” with you as a manager, and others who “beat to their own drummer”. All deserve the same evaluation criteria, and objectivity from you. The ultimate goal of the evaluation is to give good, positive feedback to the employee for the enhancement of the job, the employee, and the overall contribution to the organization.
You may want to consider having the employees do a “self-evaluation” based upon the same criteria and evaluation form that you use. Compare your evaluation to the one the employee has done , see where the two evaluations compare or contrast. Give your employees the opportunity to express concern(s) regarding their job. Be open to hearing about issues that are a hindrance to the employee. Keep your emotions out of this process. You want to gain vital information about on-going issues that affect the department first hand from the employee, and how you can effectively solve or dissipate the problem
If the employee is not meeting the goals outlined in the evaluation, spell out exactly what you want them to do to achieve the goal. Don’t fall into the trap of wanting the employee to “work harder” be specific in what you want to happen. State a quantifiable, achieveable objective such as – no more than 3 failed claims per day, or all loose filing is to be completed within 2 hours. Once you have specified what you want to happen, then give a timeline/deadline for how this improvement is to happen. You expect the employee to process XX amount of work per day, 1 month after XX training on the new system. Be honest and forthright, but do not be hurtful. No one intentionally goes to work each day with the intent of doing a poor job. Do not point out personality flaws, or imply how the employee “feels” (such as angry or emotional) instead notate the employee’s behavior (i.e. was insubordinate,)
Last but not least LISTEN TO YOUR EMPLOYEE! After all, you are their supervisor, coach, mentor, and cheerleader. Good, positive, communication between both of you during the evaluation process is critical to the continued success of you, the manager and your coding team. In addition, you will stay in tune with the needs of the department, and be quick to correct any issues or problems that arise.

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