Coding Quality Reviewer/Audit

About the role

Coding Quality Reviewer/Audit is responsible for the review of medical records to assure the accuracy of codes assigned for outpatient/inpatient medical records according to CPT-4 and/or ICD-10-CM/PCS coding rules and principles and supports a complete and accurate clinical and financial database.

Responsibilities

• Perform quality assurance audits where directed.
• Compiles results and summary findings of reviews for management review and trending analysis.
• Prepares presentations and attends Committee meetings to review results.
• Interacts with Providers and Hospital Departments related to coding guideline education.
• Delivers feedback to the coding team for educational purposes.
• Reviews coded records, analyzes, interprets and classifies clinical information in the medical record according to ICD-10-CM/PCS and/or CPT coding rules and principles.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information.
• Conducts review of coded records according to quality measures, risk variables and other specific documentation criteria, provides statistical analysis of error rates prior to bill processing.
• Share finding with coding staff for education.
• Forwards trends to claims data and regulatory quality measures.
• Attend hospital quality and service line committee meetings to represent the Coding Department as it relates to agenda items for coding review results and coding guidelines education.
• Prepare compliant queries to physicians and other clinical providers when documentation in the medical record is inadequate, ambiguous, or unclear for coding purposes.
• Participate in all Coding Department in-service meetings or training sessions to maintain and enhance coding and auditing skills to stay abreast of changes in coding guidelines/regulations.

Requirements

Extensive knowledge of medical terminology, human anatomy and physiology, and clinical disease process required. At least 10 years of coding experience. Knowledge of official coding guidelines and common billing regulations.

Qualifications

Associate Degree or BS in Health Information Management, Nursing or related field. Preferred: Knowledge of performance benchmark databases and risk variables such as Vizient, Publically reported clinical and claims data and regulatory quality measures.

Skills

Knowledge of official coding guidelines and common billing regulations.

Benefits

Comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts.

Pay

N/A

Schedule

Workday Day (United States of America)