Position: Data Quality Specialist
1099 Assignment (possibly 3-6 months)
Location: 100% Remote
Shift: Monday, Wednesday and Thursday 8am – 4pm ET
The Data Quality Specialist is responsible for assisting the assigned client with the following tasks:
- Responding to and answering coder questions
- Monitor and respond to all work queue inquiries
- Conduct chart reviews assigned by the client
- Reviews insurance denials
Essential Job Requirements
- CCS, CCS-P or CPC Required
- RHIA or RHIT Preferred
- Associate’s Degree Preferred
- Minimum of 3 years of applied experience in a Health Information Management position
3. Required Skills
- Advanced knowledge of medical terminology, ICD-10-CM coding, MS-DRGs, APR DRGs, POAs, HACs.
- Knowledge of documentation standards and improvement methodologies.
- Knowledge of auditing concepts, principles, statistics and reporting.
- Knowledge of current and developing issues and trends in coding and reimbursement systems.
- Knowledge of regulatory issues, medical coding practices, guidelines, terminology, systems, policies and procedures within the acute care and ambulatory environment.
- Strong organizational, analytical and problem-solving abilities and techniques.
- Excellent written and verbal communication skills
- Excellent interpersonal skills.
- Ability to Work independently
4. Physical Requirements
Ability to operate computers and general office equipment
1. Perform coding reviews in accordance with The Official Coding Guidelines, AHIMA Standards of Ethical Coding, CMS Rules and Regulations, AMA CPT Assistant guidelines, and AHA Coding Clinic guidelines, CCI Edits and in accordance with NCDs and LCDs as applicable, as well as with client's policies, procedures and code of conduct.
2. Perform services adhering to the policies and procedures of the Client except when in conflict with official coding guidelines.
3. Conduct data quality assessments for clients on respective accounts. Compile and report findings to client and Pena 4 Inc. coding management.
Review the coding and DRG assignment of the client’s coding staff to validate the correct DRG assignment. Any changes to DRG assignment must be documented, along with rationale for the change(s).
4. May be asked to prepare and conduct educational sessions as required. (i.e., web-based training, in-services, etc.)
5. Keep abreast of coding guidelines and reimbursement reporting requirements and maintain coding credential requirements.
6. Perform ICD-10 diagnosis/procedure and/or HCPCS coding for hospital-based inpatient and/or outpatient cases on occasion, when requested.
7. Communicate any questions or concerns related to documentation, DRG assignment or processes immediately to PENA 4 Inc. coding leadership.
8. Achieve and maintain a 95% coding accuracy rate and a 95% MS-DRG/APR-DRG accuracy rate.
Responsibilities specific to Data Quality Services:
Review, validate and correct the following data elements in each of the "inpatient" coding audits:
- Principal diagnosis (ICD-10-CM)
- Secondary diagnoses and capture of CC/MCC (ICD-10-CM)
- Present on Admission for each diagnosis (POA)
- Primary procedure (ICD-10-PCS)
- Secondary procedures (ICD-10-PCS)
- DRG assignment (MS-DRG, APR DRG)
- Severity of Illness/Risk of Mortality assignment, if applicable (SOI ROM)
Document all recommendations, including:
- Change DRG assignment after regrouping
- Change to discharge disposition
- Change to other patient demographic data if affecting coding
- Query opportunity, if coder did not initiate a query when a query is deemed warranted and required by the reviewer
- Reason and rationale for each change, add, delete
- Reference to and a copy of the respective Official Coding Guidelines, Coding Clinics, and other official and recognized regulatory rules and guidance
- Location of supporting documentation from the EMR for all suggested code changes and additions
Will immediately notify Client of any records with incomplete or unclear record or documentation that precludes accurate and/or complete coding. An incomplete record is defined as not having one or more of the following, when applicable; HIP, DIC Summary, Progress notes, Operative Reports, Pathology Reports, Procedure Reports, etc.
Review payor denials and prepare appeal letters per the Policies and Procedures of the client
Maintain confidentiality of all patient information
Assist in other related projects as necessary.
Limitations and Disclaimer
The above job description is meant to describe the general nature and level of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required for the position.'
Job Types: Part-time, Contract, Temporary
Pay: $53.00 - $59.00 per hour
- Data Quality and/or Health Information Management: 3 years (Required)
- CCS, CCS-P, CPC, RHIA or RHIT (Required)
Work Location: Remote