RCS-Quality Expert CC

This position supports Revenue Cycle Services' Total Quality Management team by performing quality reviews, providing feedback to operational team members and other departments, and assisting in the development of Standard Work. The role ensures the accuracy and completeness of clinical medical record documentation and clinical coding, impacting patient status assignment, care documentation, billing, and hospital reporting. The position is also involved in various quality initiatives across the Indiana University Health system.

Responsibilities

• Develop and perform ongoing quality reviews on operational team members to ensure appropriate levels of quality performance.
• Conduct individual feedback sessions with team members to discuss quality review results and assist with continued review of areas of concern.
• Prepare and submit formal quality reports to operational management on team members’ results.
• Assist with new team member training in preparation for their move to operations.
• Evaluate the educational needs of team members based on findings, trends, or leadership requests.
• Assist with the identification and development of training topics/resources for team members.
• Evaluate, coordinate, and complete both internal and external quality reviews/audits within defined timeframes.
• Serve as a member of various committees/teams both internal and external to Revenue Cycle Services.
• Monitor departmental compliance with policies, procedures, guidelines, and rules; provide suggestions for improvement.
• Maintain expertise in relevant areas of responsibility (coding, statusing/level of care, certification/authorization, chart completion, etc.).
• Communicate professionally, appropriately, and effectively via both written and verbal methods with internal and external individuals/groups.
• Provide support for additional special projects as directed by leadership.
• Provide coverage in operational areas on an as-needed basis to remain current on operational workflow and functions.

Requirements

• 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 preferred.
• 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 professional correspondence and presentations to all organizational levels.
• Ability to establish and maintain collaborative working relationships.
• Ability to set and adjust defined priorities, process multiple tasks, and work with confidential information.
• Strong attention to detail, problem-solving, and critical thinking skills.
• Proficiency in Microsoft Office applications (Word, Excel, PowerPoint, OneNote, Visio, and Access).
• Commitment to IU Health’s mission, vision, and values, demonstrating behaviors and delivering results that align with the organization’s strategic direction.