Inpatient/Outpatient Internal Quality Reviewer

Start date: ASAP

About the role

The Internal Quality Reviewer in Health Information Management serves as an expert resource to the Manager of Internal Quality, Lead Auditors, fellow auditors, Coding Workforce Managers, and coding staff. This position is responsible for auditing and providing education for Inpatient and Outpatient Coders, as well as Revenue Cycle Solutions Consultants, ensuring client satisfaction. A dedicated schedule of 40 hours per week is required.

Responsibilities

• Conducts initial pre-bill and/or onboarding reviews and monthly audits for Revenue Cycle Solutions Consultants per designated schedule.
• Audits and analyzes coded data to identify aberrant coding practices that do not align with established coding policies and procedures.
• Coordinates and provides feedback to coders and, when necessary, Workforce Managers.
• Continuously meets productivity expectations, per complexity indices, determined for each client specifically to the area audited.
• Maintains daily schedule and covers audits for Inpatient and Outpatient Coding, assisting when gaps are identified.
• Proactively takes action to ensure all client commitments are met.
• Completes all assigned audits by the 5th of the following month.
• Responds to management within 1-2 business hours, unless otherwise determined by the manager.
• Responds to Coding Consultant Rebuttal responses within 24 hours for Pre-bill/Onboarding Audits and within 24 hours for Monthly Audits.
• Compiles and follows through on all processes entailed in audits and client obligations.
• Identifies trends in inpatient coding, as well as DRG validation, and recommends focus areas for further coding education to Workforce Managers and the Internal Quality Manager.
• Adheres to the ‘Standard Terminology for Auditor Recommendations’ Policy.
• Utilizes industry-recognized references to support review findings, such as the ICD-10 Official Guidelines for Coding and Reporting, AHIMA Standards of Ethical Coding, AHIMA Practice Briefs related to compliant querying, and AHA Coding Clinics.
• Updates systems with all vital audit information within 24 hours of an audit being finalized.
• Assists in providing client and coder support with coding, query writing, and audit questions, as requested.
• Provides education to coders when audits are below 95%, as requested.
• Performs miscellaneous job-related duties, as assigned.
• Communicates issues as needed to the Manager of Internal Quality.
• Provides timely communication in response to customer-related issues, as well as any internal audit-related questions, to ensure a successful experience.
• Develops and maintains supportive and positive relationships with all employees.

Requirements

• 3+ years of coding and/or auditing experience.
• Experience with various Encoder software programs.
• Basic understanding of healthcare billing/accounting systems/healthcare revenue cycle.
• Understanding of physician query processes.

Qualifications

• Bachelor’s Degree (Preferred, not required).
• Certifications (Required):
  • Certified Coding Specialist (CCS) | American Health Information Management Association (AHIMA), OR
  • Certified Professional Coder (CPC) | American Academy of Professional Coders (AAPC).
• Certifications (Preferred):
  • Certified Professional Medical Auditor (CPMA) | AAPC.
  • Registered Health Information Administrator (RHIA) | AHIMA.
  • Registered Health Information Technician (RHIT) | AHIMA.

Skills

• Excellent organizational and computer technical skills.
• Proficiency with MS Word, Excel, and PowerPoint.
• Ability to use coding references such as Coding Clinic, Current Procedural Terminology Assistant, etc.
• Ability to perform multiple audits and meet deadlines.
• Ability to handle conflict and offer actionable resolution.

Pay

$45.00 - $60.00 per hour

Benefits

• Medical, dental, and vision benefits.
• Earned time off and paid holidays.
• Paid continuing education time.
• 401(K) retirement planning.
• Short-term disability, life insurance, paid jury duty.
• Access to the largest network of facilities and providers in the country.
• Industry-experienced workforce management team.
• Licensure and certification reimbursement.

Location

Winston-Salem, referred to as North Carolina’s “City of the Arts,” is rated as one of “America’s most livable communities.” Located halfway between Atlanta, Georgia, and Washington, D.C., it serves as an important city in the South Atlantic Region and a hub for the industries of medicine and finance.