Supervisor, Coding Quality Auditor

Hackensack Meridian Health•Red Bank, NJ

1d•Onsite

About The Position

The Supervisor, Coding Quality Auditor oversees the Coding Quality Auditors and monitors compliance with the Office of the Inspector General (OIG), Hospital acquired condition (HAC) and target review Diagnosis Related Group (DRG's) for Hackensack Meridian Health (HMH) network. Also responsible for monitoring compliance with applicable clinical documentation to support coding and billing regulations to insure appropriate reimbursement for HMH Network.

Requirements

High School diploma, general equivalency diploma (GED), and/or GED equivalent programs.
Minimum of 5+ years of experience coding/auditing inpatient accounts in an acute care setting.
Excellent computer skills with a strong knowledge of Microsoft Office.
Knowledge of ICD-10-CM/PCS and DRG methodologies.
Knowledge of data reporting requirements and ability to prepare and present results to multi disciplinary teams.
Knowledge in Patient Safety/Quality Management.
Knowledge of POA/HAC, PSI and core measures.
Extensive knowledge in data collection and clinical reviews.
Excellent written, verbal and interpersonal communication skills.
Proficient computer skills including but not limited to Microsoft Office and Google Suite platforms.
Certified Coding Specialist.

Nice To Haves

Associate or Bachelor's degree in Health Information Technology or management.
Minimum of 10 years of experience in Medical Record ICD-10-CM/PCS and DRG methodologies.
Registered Health Information Administrator Certification or Registered Health Information Technician or Registered Nurse.

Responsibilities

Reviews DRG assignment for selected Medicare/Medicaid inpatients for the purpose of reimbursement, research and statistics in compliance with federal regulations according to International Classification of Diseases 10th Diagnosis & Procedure Coding System (ICD-10-CM/PCS) coding classification systems.
Assist in coordinating workflows with Clinical Documentation Improvement (CDI) team regarding quality indicators reviews (i.e. Mortality, Patient Safety Indicators (PSI), Hospital Acquired Conditions (HAC), Severity of Illness (SOI), Risk of Mortality (ROM) etc.)
Analyzes physician documentation in the medical record for coding accuracy.
Acts as a Superuser for implementation of various computer-related initiatives that affect the Health Information Management (HIM) department such as EPIC, front-end coding, 3M/360, etc.
Assists the inpatient coding manager with coordinating the work activities in the coding section of the HIM department.
Assists the Inpatient Coding Manager with education sessions for the staff.
Assists the HIM team with projects and reviews assigned to HIM which include, but are not limited to, Patient Safety Indicators (PSI), Hospital Acquired Conditions (HAC), ICD-10, 3M/360, clinical reviews, audits, as well as various other projects.
Coordinates the daily work activities of the Coding Quality Validators. Ensures adequate staffing of the Coding Quality Validation (CQV) team to prevent any negative impact on AR.
Assists in the coordination of all statistical compilations for HIM as well as those requested from various departments.
Generates monthly compliance reports of selected DRG's, APC's, HAC, etc and compile data to report findings to corporate compliance and other departments as appropriate.
Assists in peer interviews as well as lends recommendations regarding the hiring, terminating or extension of probation periods of trainees based on performance.
Maintains productivity and accuracy reports.
Performs chart reviews for second opinion or when further review is necessary.
Attends all management associated meetings as required.
Acts as a resource for the staff as well as various other departments.
Provides support for other supervisors as needed; responsible for the CQV team payroll.
Other duties and/or projects as assigned.
Adheres to HMH Organizational competencies and standards of behavior.