Coding Quality Review Specialist -Inpatient

About The Job

General Summary of Position: The Inpatient Coding Quality Review Specialist is responsible for providing expert review to ensure the quality and integrity of medical records. Responsibilities include validating ICD-10-CM/PCS codes, examining medical record documentation, assigning present on admission (POA) indicators, and reviewing Quality indicators such as MHACs, HACs, PSIs, and Mortality reviews.

Responsibilities

• Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards.
• Complies with governmental and accreditation regulations.
• Aids in the development of system-specific coding guidelines as needed and participates in Quality review team meetings.
• Uses knowledge of coding compliance plan to direct efforts to achieve plan by focusing on areas identified through coding reviews or targeted by management for improvement.
• Selects areas for focused quality reviews.
• Maintains continuing education.
• Maintains credentials for required job classification.
• Mets established Quality, Accuracy, and Productivity standards as defined by policies.
• Provides/identifies trends to provide feedback to appropriate sources.
• Identifies and assists in areas requiring additional training/education under the direction of Manager.
• Queries the medical staff and other caregivers as necessary to obtain accurate and complete physician documentation that supports the severity of the patient illness and risk of mortality.
• Performs retrospective reviews on coding staff.
• Reviews, analyzes, and interprets medical record documentation to identify diagnoses and procedures. Assigns correct ICD 10-CM and ICD 10-PCS codes using standard guidelines and automated encoding software. Assigns the appropriate DRG.
• Works closely with the Coding Quality Review team to identify areas for improvement and problematic cases.
• Participates in multi-disciplinary quality and service improvement teams.

Qualifications

• Education: High School Diploma or GED required. Vocational/Technical Degree or certificate in Health Information Management, Health Information Technology, or similar field with successful completion of medical terminology, Anatomy and Physiology, and Coding courses in ICD-10 CM and PCS preferred.
• Experience: 1-2 years inpatient coding experience, preferably in an acute care setting required. 3-4 years auditing experience preferred.
• Licenses and Certifications: AHIMA (American Health Information Management Association) CCS required. Certificate as a Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or Certified Inpatient Coder (CIC AAPC) preferred.

Knowledge, Skills, and Abilities

• Excellent verbal and written communication skills.
• Excellent interpersonal skills.
• Strong computer skills preferred.

Pay

This position has a hiring range of USD $31.28 - USD $56.39 /Hr.