Position Purpose
To provide on-going quality assurance activities for respectively assigned client engagements in order to ensure the highest level of coding quality of company resources.
Position Summary
Responsible for performing coding quality improvement and oversight for coding and data quality engagements by assessing coding accuracy and to maintain internal and client-specific accuracy requirements. QIC is responsible for coordinating quality management efforts including development, implementation, education, data collection and analysis.
The QI Coordinator is also responsible for providing consulting services and acting as subject matter expert to existing and new clients. Consultant may be required to perform consulting services remotely, to ensure billable hours are generated for the company. The set goal is to generate revenue equal to 1 (one) times annual salary, by performing billable hours for clients, or through referrals which lead to new contracts and additional revenue equal to 1 (one) times annual salary.
Essential Job Requirements
1. Education: Associate degree required; Bachelor degree preferred
2. Experience: Minimum of 5-7 years of H.I.M. and coding experience, with at least 5 years of coding quality assurance experience (auditing), IP Coding and Auditing experience.
3. Credentials/Certifications: CCS and/or RHIA/RHIT required. Additional credentials (CPMA, CCS-P, CPC, COC, CIC, or CRC) are preferred.
4. Required Skills:
- Advanced knowledge and performance of ICD-10-CM/PCS coding, MS-DRGs, APR- DRG’s, POAs, HACs, PSIs, medical terminology, and pharmacology.
- Advanced knowledge of documentation standards and improvement methodologies.
- Strong Proficiency in auditing concepts, principles, statistics, and reporting.
- Knowledge and use of grouper and encoder systems, 3M/Nuance Clintegrity preferred.
- Knowledge and use of EMRs, Epic/Powerchart preferred
- Strong Proficiency in ICD-10 CM/PCS, MS-DRG, APR-DRG chart auditing.
- Strong organizational, analytical, and problem-solving abilities and techniques with excellent communication and interpersonal skills.
- Ability to work independently in a remote environment.
5. Preferred Skills: Strong Proficiency in MS Office. (Word, Excel, PowerPoint)
6. Productivity Standards: 15-18 inpatient cases per 8-hour shift, varies per client and project assignment
Position Responsibilities
1. Ensure that coding services to clients adhere to the AHA Official Coding Guidelines, Coding Clinics, UHDDS definitions, and AHIMA and CMS standards of ethical coding.
2. Reviews medical record documentation to ensure that coding staff perform services according to the policies and procedures of the client (except when in conflict with official coding guidelines), and that coding and abstracting is complete and accurate using ICD-10-CM and ICD-10-PCS coding classification systems.
3. Conduct data quality assessments of coding resources for respective accounts and compiles report findings to management and clients as appropriate.
4. Conduct root cause analysis (RCA) of audit findings to identify coding/documentation error trends.
5. Translate RCA outcomes into targeted corrective action plans and follow up with coders to ensure improvements.
6. Ensure accountability by monitoring completion of corrective actions tied to RCA results.
7. Serve as subject matter expert for the coding processes and guidelines related to respective assigned accounts, proactively identify trends and training requirements. Partner with the education team to develop training materials (tip sheets, coding refreshers, coding clinics) based on RCA findings.
8. Develop and maintain documentation related to quality improvement activities, including policies procedures, reports and Client-Specific Coding Guidelines for respective client engagements.
9. Track coder performance month-over-month post-education to confirm sustained improvements in accuracy.
10. Provide support to clients, consultants & employees as related to coding, abstracting and data quality for respective accounts.
11. Provide monthly summaries of trends/errors to Coding Leadership for oversight and escalate concerns to the respective Team Lead and/or production management team, and Coding and Quality Improvement management team for resolution as necessary.
12. Facilitate communication across Coding, CDI, Billing and Customer Support teams on error trends and resolutions.
13. Assist management with planning, designing, implementing, and maintaining a comprehensive medical practice continuous quality improvement (CQI) program including utilization management and risk management.
14. Evaluate variances and other data to identify QI opportunities and risk management issues.
15. Keep abreast of coding guidelines and reimbursement reporting requirements and maintain coding credential requirements. Stay up to date on industry best practices and emerging trends in quality management.
16. Perform ICD-10 diagnosis/procedure coding for hospital-based inpatient cases, within scope of expertise.
17. Perform/assist in inpatient data quality reviews and audits as necessary, within scope of expertise.
18. Assists in the development and delivery of coding educational sessions for assigned client engagements as per the contractual commitment, or as requested.
19. Achieve and maintain a monthly coding accuracy and DRG accuracy rate of 95% or above.
20. Act as consultant and subject matter expert for existing and new clients
21. Perform consulting services for clients remotely, to ensure billable hours are generated for the company
22. Generate revenue equal to 1 (one) times annual salary, by performing billable hours for clients, or through referrals which lead to new contracts and additional revenue
23. Assist in other related projects as necessary.
Pay: $80,000.00 - $90,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Employee discount
- Health insurance
- Life insurance
- Paid time off
- Professional development assistance
- Referral program
- Vision insurance
Experience:
- Inpatient (ICD-10-PCS and CPT) coding and auditing: 4 years (Required)
License/Certification:
- CCS from AHIMA (Required)
Work Location: Remote
