RCS-Quality Expert CC

This position exists to support Revenue Cycle Services' Total Quality Management team. The role involves performing various quality reviews, preparing and providing feedback to operational team members and other departments, and assisting in the development of Standard Work for team members. The position ensures the accuracy and completeness of clinical medical record documentation and clinical coding as it pertains to patient status, care documentation, billing support, and hospital reporting. Additionally, this role will be involved in various quality initiatives across the Indiana University Health system.

Responsibilities

• Develops and performs ongoing quality reviews on operational team members to ensure appropriate levels of quality performance.
• Conducts individual feedback sessions with team members to discuss quality review results and assists with continued review of areas of concern.
• Prepares and submits formal quality reports to operational management on team members' results.
• Assists with new team member training in preparation for their move to operations.
• Evaluates the educational needs of team members based on findings, trends, or leadership requests.
• Assists with the identification and development of training topics/resources for team members.
• Assists with the evaluation, coordination, and completion of both internal and external quality reviews/audits within defined timeframes.
• Serves as a member of various committees/teams both internal and external to Revenue Cycle Services.
• Monitors departmental compliance with policies, procedures, guidelines, and rules, providing suggestions for improvement.
• Maintains expertise in relevant areas of responsibility (coding, statusing/level of care, certification/authorization, chart completion, etc.).
• Communicates professionally, appropriately, and effectively via both written and verbal methods with internal and external individuals/groups.
• Provides support for additional special projects as directed by leadership.
• Provides coverage in operational areas on an as-needed basis and to remain current on operational workflow and functions.

Requirements

• Requires RHIA, RHIT, CCS, CCS-P, CPC, CIC, or COC certification, or an active Registered Nurse (RN) license in the state of Indiana or an active Nurse Licensure Compact (NLC) RN license.
• High School Diploma required; Associate or Bachelor Degree in Health Information Management, Coding, Nursing, or Finance is preferred.
• ASN required, BSN preferred (based on position/focus).
• Six Sigma or Lean Six Sigma training preferred.
• 5+ years of experience in revenue cycle operations in roles related to utilization management, coding, billing, collections, payment adjustments, auditing, denial management, and medical record completion.
• Ability to read, understand, and interpret medical records and other treatment documentation.
• High level of interpersonal, problem-solving, and analytic skills.
• Effective written and verbal communication skills for individual and group settings, ensuring professional correspondence and presentation to all organizational levels.
• Ability to establish and maintain collaborative working relationships.
• Ability to set and adjust defined priorities and process multiple tasks simultaneously.
• Strong attention to detail, problem-solving, and critical thinking skills.
• Ability to work with and maintain confidential information.
• Proficiency in Microsoft Office applications (Word, Excel, PowerPoint, OneNote, Visio, and Access).
• Demonstrates a commitment to IU Health's mission, vision, and values by exhibiting behaviors and delivering results aligned with the organization's strategic direction.

About the Organization

Indiana University Health is the largest health system in Indiana, with nearly 40,000 team members, 15 hospitals, and $8.64 billion in operating revenue. The system's programs in cancer, cardiovascular, neuroscience, orthopedics, pediatrics, and transplants have received national recognition for quality patient care. IU Health, in partnership with the Indiana University School of Medicine, brings together highly skilled physicians, researchers, and educators to provide world-class care for children and adults and improve the health of patients and communities across Indiana.