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Quality Assurance Specialist (Medical Coding/CDI)

Accuity
Mt Laurel, NJ 08054
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    149347957

Accuity Delivery Systems was founded in 2016 with the goal of reinventing the Clinical Documentation Process through MD case review, and MD to MD education. Over the last five years, we have experienced rapid growth and are excited to continue in growing our team nationwide. Learn more about us at www.accds.com.

Position Summary

The Quality Assurance (QA) Specialist is responsible for performance of internal coding QA reviews. These reviews provide an additional layer of internal coding quality and compliance of inpatient (IP) records to assure appropriateness and accuracy of code assignments in accordance with Center of Medicare and Medicaid (CMS) guidelines and client facility specific coding guidelines.

This position reports to the Quality Assurance (QA) Manager.

Primary Responsibilities

  • Performs IP coding quality assurance (QA) reviews
  • Maintains turnaround time expectations to minimize impact to client DNFB
  • Maintains an up-to-date working knowledge of MS-DRG, APR-DRG, ICD-10 CM/PCS Coding Clinics
  • Identify, apply, and validate the use of current industry standard clinical indicators, risk factors and treatment protocols used in clinical validation of payment impacting code assignment
  • Actively and skillfully conceptualizes, applies, analyzes, synthesizes, and evaluates information gathered from, or generated by observation, experience, reflection, reasoning, or communication as a guide to validate review results/findings and correct, as necessary
  • Abstracting and performing a comprehensive review of the medical record to assess the documentation present/absent as it compares to the base code set impacting payment, or a requested change in coding
  • Review scope includes validation of the MS-DRGs and APR-DRGs assigned for Medicare, Medicaid, commercial, and third-party claims
  • Writing a query ask with clinical indicators and/or documentation excerpts if a discrepancy or gap exists in the medical record documentation and the (base, desired) code assignment per application of Official Coding Guidelines, or if a medical condition does not appear to be clinically supported or meeting clinical criteria requirements
  • Documenting the finding and the corrections to be made in a clear and compelling manner along with accurately and concisely providing the supporting evidence from the medical record and/or references; the knowledge and application of effective reconciliation and rebuttal strategies
  • Develops and maintains a strong understanding of Accuity and of client specific technology, policy, procedures, guidelines, and workflows
  • Ensures strict confidentiality of patient information
  • Accountable for meeting or exceeding both production and quality expectations
  • Meets or exceeds short-term and long-term goals as established for the department
  • May require schedule flexibility and change to accommodate workflow
  • Participates in staff meetings and attends other meetings and seminars as required
  • Assist in special projects and other roles and responsibilities as needed to support Accuity
  • Performs miscellaneous job-related duties as assigned



Education:

  • Associates Degree in Health Information Management required
  • Bachelor's Degree or Master's Degree in Health Information Management preferred
  • Clinical license or RHIA/RHIT with coding credential required from AHIMA and/or AAPC required
  • CCDS or CDIP preferred
  • Maintains credentials through completion of annual CEU requirements

Experience:

  • Minimum 5 years of hospital or vendor inpatient coding and/or CDI experience required
  • Minimum 2 years coding QA experience
  • Experience with electronic health records and health information systems
  • Government program integrity experience highly preferred
  • Certifications and/or professional license must be maintained as a condition of employment
  • Maintains subject matter expertise in clinical validation criteria and practices, ICD-10-CM/PCS code sets, coding guidelines, clinical documentation integrity, and inpatient payment methodologies as a condition of employment
  • Demonstrated knowledge of MS and APR-DRGs
  • Demonstrated knowledge of all applicable Coding Clinics as they relate to current IP coding practices

Knowledge, Skills, and Abilities:

  • ICD-10-CM/PCS coding expertise including POA assignment and Discharge Disposition codes
  • Expert knowledge of Official Coding Guidelines, advanced knowledge of APR and MS DRG reimbursement models, state, and federal regulations
  • Knowledge of AHRQ Quality Metrics including patient safety indicators (PSIs), Hospital Acquired Conditions (HACs), Vizient Mortality Models, CMS Core Measures, other national patient safety quality indicators, and different payor categories
  • Knowledge of quality assurance concepts and principles
  • Solid command of anatomy, physiology, pathology, laboratory, imaging, pharmacology, disease assessment, patient management, and treatment
  • Knowledge of legal, regulatory, and policy compliance issues related to medical coding and documentation
  • Knowledge of current and developing issues and trends in medical coding diagnosis and procedure code assignment
  • Advanced knowledge of medical coding, electronic medical record systems, and coding systems
  • Ability to use independent judgment and to manage confidential information
  • Ability to analyze and problem solve
  • Detail oriented with ability to multi-task
  • Strong communication (written and oral) and interpersonal skills
  • Ability to clearly communicate information to coders, physicians, and CDI staff
  • Ability to provide guidance and training to Accuity coding, physician, and CDI staff
  • Ability to use a PC in a Windows environment, including MS Word
  • Independent, focused individual who takes initiative and is able to work remotely or on-site
  • Able to execute under the pressure of time constraints and maintain focus over period of work hours
  • Demonstrates ability to work independently as well as cooperatively with various teams
  • Serves as a professional role model for internal and external customers





PI149347957

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Posted: 2021-10-05 Expires: 2021-11-05

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Quality Assurance Specialist (Medical Coding/CDI)

Accuity
Mt Laurel, NJ 08054

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