Quality Specialist (Inpatient)

Pena4, India

Website: pena4.com
Job details:

Responsibilities:

Reviews medical record documentation for accuracy in code assignment of the primary/secondary diagnosis and procedures using ICD-10-CM/PCS and CPT coding conventions and DRG/APC assignment  

Provides completed data quality findings in specified turnaround time.  

Keeps abreast of coding guidelines and reimbursement reporting requirements.  

Documents quality data on teams of coders and records findings in designated system and in narrative documents (i.e. Executive Summary)  

Coordinates scheduled quality meetings with the QA and production staff.  

Provides internal data quality reviews as needed  

Attends client meetings and speak to data quality findings  

Assists with research and development and presentation of continuing education programs on areas of specialization.  

Understands and abides by the organization’s information security policy and protect the confidentiality, integrity, and availability of all information assets.  

Perform other responsibilities as assigned.  

Education/Experience:

Bachelor’s Degree. Advanced degree desirable. 

5+ years of inpatient medical coding experience with exposure to at least three inpatient clients' coding. Senior medical coders with quality audit experience and/or those currently designated as Quality Analysts and Team Leads 

Required Skills:

Proficiency in ICD-10 CM and ICD-10 PCS coding, and strong knowledge of CMS, AHIMA, and AHA coding guidelines. 

Advanced knowledge of medical terminology, ICD-10-CM/PCS coding, MS-DRGs, APCs, POAs, and HACs. 

Knowledge of documentation standards and improvement methodologies. 

Knowledge of auditing concepts, principles, statistics, and reporting. 

Knowledge of grouper and encoder systems, EPIC, 3M 360, Nuance Clintegrity360 preferred. 

Proficient in ICD-10 CM/PCS, CPT coding 

Strong organizational, analytical, and problem-solving abilities and techniques with excellent communication and interpersonal skills. 

Ability to manage people, schedules, workflow, and production. 

Ability to work independently in a remote environment. 

Certifications:

Any coding certification from AHIMA and/or AAPC

Preferred Skills:

Strong Proficiency in MS Office. (Word, Excel, PowerPoint) 

Strong verbal and written communication skills in the English language. 

Simultaneous oversight of multiple accounts, resources, and processes. 

Knowledge of encoder software, Medicare DRG, APC coding, and charging/billing process. 

 

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