PROFESSIONAL AUDITOR, QA ANALYST
This role is responsible for coding compliance initiatives being met for all clients. Reviews and analyzes medical records and abstracted data submitted by the remote coding staff to determine the accuracy of payment and code assignment and adequacy of clinical documentation in accordance with regulatory requirements. Implements the ICD-10-CM/PCS training program and other education as needed. Provides quality reviews and educational classes for staff and clients.
Director – Professional Coding & Audit Services
- Meet client deadlines
- Conduct quality reviews.
- Subject matter expert for coding questions from the coders and clients
Essential Job Functions:
Complete the following functions in accordance with CodingAID policies:
- Maintains up-to-date knowledge of regulatory changes impacting coding requirements and ensures coding staff are appropriately educated.
- Responsible for systematic approaches that contribute to a quality health record, while maintaining strong regulatory and legal compliance, and high levels of customer service.
- Assists with implementing, developing and maintaining coding quality program.
- Serves as an educator for the coders and other healthcare professionals/departments in the use of coding guidelines and proper documentation requirements as it relates to data quality management and reimbursement.
- Performs QA reports.
- Subject matter expert and resource to internal and external stake holders
- Ability to successfully perform coding quality reviews to validate correct coding for coders following CodingAID’ s Corporate Compliance Plan and Quality Review guidelines.
- Provide feedback to coding staff on quality review results.
- Provide ICD-10-CM/PCS training to new and existing staff as needed.
- Provide training on areas where coding compliance is not met.
- Maintain ongoing communication with management, coding staff and clients to ensure target coding compliance goals are met.
- Assist manager with performing new employee orientation including scheduling training.
- Create and maintain both internal and external coding protocols
- Comply with CodingAID’ s policies regarding the use and disclosure of protected health information which includes accessing and using protected health information only to the extent necessary to fulfill the above mentioned responsibilities.
- Help ensure internal and external client reporting happens in a timely fashion
- Review and/or prepare client billing information for division services and forward to Director of Operations for final approval.
- Ensure compliance with federal and state laws, regulations, and standards related to health information and coding principles.
- Other duties as assigned
- Must have one of the following current credentials, RHIT, RHIA and/or CCS
- AHIMA ICD-10-CM/PCS
- High level coding expertise in IPPS and OPPS.
- A minimum of five years’ experience required abstracting ICD-10-CM/PCS, present on admission indicators (“ POA”), APR-DRG & MS-DRG, HCPCS, CPT, Modifiers & APC assignment
- Requires advanced technical knowledge in specific surgical and medical specialties as assigned.
- Extensive knowledge of medical terminology and ability to research coding related questions.
- Must have experience with data entry of codes into a database and/or software tool.
- Must have experience with remote and/or face to face provider education.
- Knowledge and proficiency of Coding software and computer skills in Microsoft Office and products Word, Excel, PowerPoint, Access and EMR (Electronic Medical Record) systems.
- Excellent oral and written communication skills.
- Must be able to successfully pass Federal Background Check.
- Ability to work independently in a fast-paced environment
- Ability to interact with management personnel
- Possess strong organizational skills and attention to detail
- Ability to multi-task and meet multiple deadlines
- Proven ability to prioritize
- Strong communication, administrative and organizational skills
- Adaptive and flexible to new ideas and change
- Ability to work in a changing environment
- Participate in special projects as needed
Managed Resources Inc./CodingAID is an Equal Opportunity Employer (EOE) M/F/D/V/SO