Lead Inpatient Quality Specialist

CorroHealth•Plano, TX

11d

About The Position

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. JOB SUMMARY: CorroHealth is seeking a Lead Inpatient Quality Specialist. ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member. Performs complex retrospective analysis of medical record documentation to identify coding and billing errors and inconsistencies according to guidelines of the AHA, CMS, AMA, Clinic Coding Clinic and CPT Assistant. Analyzes audit findings to identify potential root causes of coding errors and prevent their reoccurrence Provides second –level review of diagnosis, procedure and billing codes to ensure compliance with legal and procedural policies that ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices. Research, analyze and respond to inquiries regarding compliance, inappropriate coding, denials and billable services Provides technical support and feedback training to internal coding staff regarding coding compliance, documentation, regulatory provisions, third part payer requirements, medical necessity requirements Protects the privacy and confidentiality of patient health and client information. Follows the Standards of Ethical Coding as set forth by AHIMA and adheres to official coding guidelines and compliance practices. Suggests physician query opportunities query Physicians based upon documentation and clinical needs. Prepare deliverables for the coders as required Report work time and work productions in a timely and accurate manner Communicates with coworkers in an open and respectful a manner which promotes teamwork and knowledge sharing. Provide schedule of planned work activities, events and sites, and any changes to same to management and appropriate staff. Maintenance of professional coding credentials and knowledge of coding, reimbursement methodologies and compliance issues through education Monitor the on-going progress and success of each coder Maintain QA percentages within two internal quality goals; 1) overall minimum coder accuracy of 95% and 2) QA review percentages as close to 10% as possible Identify and resolve coding quality problems or issues in a timely manner Maintain a continual knowledge of problems or issues that could affect coding quality levels Assist in design of systems to help improve coder productivity and assist in improving accuracy of coding Provide monthly reports Participate in corporate training and meetings Provide status reports to senior manager as requested Align conduct with AHIMA's Standards of Ethical Coding and the Company’s Code of Ethics and Business Conduct and support the Company’s Ethics and Compliance Program Interpret coding guidelines for accurate code assignment Identify the importance of documentation on code assignment and the subsequent reimbursement impact Comply with all internal policies and procedures Actively participate in Company provided training and education Ensure individual compliance with all privacy and security rules and regulations and commit to the protection of all Company confidential information, including but not limited to, Personal Health Information

Requirements

Regular, predictable and punctual attendance is required
Strong verbal and written communication skills are required
Ability to prioritize workload, meet deadlines and maintain a high level of quality and accuracy
Recognized coding credential from AHIMA or AAPC; and RHIA or RHIT may also be considered
Experience with telecommuting and electronic medical records systems strongly preferred
Strong analytical skills
Excellent written communication skills
Strong team player
Ability to work with multiple and diverse clients and projects
Ability to work with minimal supervision
5-7 years’ experience coding and/or auditing in an acute care facility or clinic, of patient types listed in the Job Summary of this document
Initiative, resourcefulness and attention to detail
Customer service support -- minimum one (1) year experience
Familiarity with hospital outpatient billing processes
Understand hospital APC assignment and associated coding and documentation
Strong communication skills, proficient in Microsoft Office applications including Word and Excel
Ability to navigate in a variety of EMR environments and review hand-written charts

Nice To Haves

Coding Certification -- preferred (CPC or CCS)

Responsibilities

Performs complex retrospective analysis of medical record documentation to identify coding and billing errors and inconsistencies according to guidelines of the AHA, CMS, AMA, Clinic Coding Clinic and CPT Assistant.
Analyzes audit findings to identify potential root causes of coding errors and prevent their reoccurrence
Provides second –level review of diagnosis, procedure and billing codes to ensure compliance with legal and procedural policies that ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices.
Research, analyze and respond to inquiries regarding compliance, inappropriate coding, denials and billable services
Provides technical support and feedback training to internal coding staff regarding coding compliance, documentation, regulatory provisions, third part payer requirements, medical necessity requirements
Protects the privacy and confidentiality of patient health and client information.
Follows the Standards of Ethical Coding as set forth by AHIMA and adheres to official coding guidelines and compliance practices.
Suggests physician query opportunities query Physicians based upon documentation and clinical needs.
Prepare deliverables for the coders as required
Report work time and work productions in a timely and accurate manner
Communicates with coworkers in an open and respectful a manner which promotes teamwork and knowledge sharing.
Provide schedule of planned work activities, events and sites, and any changes to same to management and appropriate staff.
Maintenance of professional coding credentials and knowledge of coding, reimbursement methodologies and compliance issues through education
Monitor the on-going progress and success of each coder
Maintain QA percentages within two internal quality goals; 1) overall minimum coder accuracy of 95% and 2) QA review percentages as close to 10% as possible
Identify and resolve coding quality problems or issues in a timely manner
Maintain a continual knowledge of problems or issues that could affect coding quality levels
Assist in design of systems to help improve coder productivity and assist in improving accuracy of coding
Provide monthly reports
Participate in corporate training and meetings
Provide status reports to senior manager as requested
Align conduct with AHIMA's Standards of Ethical Coding and the Company’s Code of Ethics and Business Conduct and support the Company’s Ethics and Compliance Program
Interpret coding guidelines for accurate code assignment
Identify the importance of documentation on code assignment and the subsequent reimbursement impact
Comply with all internal policies and procedures
Actively participate in Company provided training and education
Ensure individual compliance with all privacy and security rules and regulations and commit to the protection of all Company confidential information, including but not limited to, Personal Health Information