Lead Inpatient Quality Specialist

 About Us:

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:

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

Qualifications and 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
• Coding Certification -- preferred (CPC or CCS)
• 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

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.