Inpatient Coding Quality Specialist

Benefits:

• HMO with FREE dependents
• Group life insurance
• 10% Annual Performance Incentive
• Annual Appraisal
• 20 Paid Time Off (PTO) per year
• Permanent Work From Home arrangement

Work Arrangement

• Permanent work from home setup

Qualifications:

• At least 4-5 years of experience performing inpatient medical record coding
• At least 2 years of experience in coding quality review work
• Must have: AHIMA or AAPC coding credentials (CPC, CIC, CCS)

Position Summary:

• The IP Quality Specialist performs coding quality operational reviews on inpatient encounters, tracks and reports coder quality errors, provides real-time feedback to coders, and trains coders on coding and medical record systems as well as workflow processes.
• Understands, interprets and applies coding guidelines for coding quality reviews. Reviews inpatient and profee encounters with complex code assignments. Review of complex medical records to determine coding accuracy of all documented diagnoses and procedures. Reviews claims to validate submitted codes and abstracted data including but not limited to ICD-10-CM//PCS codes, MS-DRGs, APR-DRGs, CPT’s, APC’s, and discharge disposition which all impact facility reimbursement and RVUs which impact profee reimbursement.
• Performs ad hoc coding quality reviews; coordinates prebill reviews, IQRs, coordinates and develops educational sessions; assists with creation of client and vendor reports; assists with training new auditors; coordinates and performs peer reviews; assists with tracking the completion of MQRs; assists with identifying and analyzing coder and coding trends; and performs training and coding quality reviews for Coder Mentoring Program.
• Creates clear and accurate review findings and recommendations in written reports that will be used for advising and educating Coders, Auditors, Managers, and Directors throughout the organization.
• Identifies documentation issues (lacking documentation, missed physician queries, etc.) that impact coding accuracy. Clearly communicates (verbally and in written reports or summaries) opportunities for documentation improvement related to coding issues.
• Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM and CPT coding. Completes online education courses and attends mandatory coding workshops and/or seminars (IPPS and OPPS, ICD-10-CM and CPT updates) for inpatient, outpatient, and ProFee coding. Reviews AHA and CPT quarterly coding update publications. Attends all internal conference calls for Quarterly Coding Updates