Coding Quality Reviewer - CPC / CCS Required - PRN

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Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

About the Role:

Job Summary

The Coding Quality Reviewer I is responsible for performing quality analysis of coded medical records, documentation of the analysis, summarizing the metrics and reporting quality statistics to management. The Coding Quality Reviewer is also responsible for communication of identified issues to coding staff and management, as well as reviewing and correcting coding issues from the EMR and PMS systems. In addition, the Coding Quality Reviewer may be called upon to provide education to staff and clients, prepare coding audits for physician education, and/or coding charts as business needs dictate. The Coding Quality Reviewer I is responsible for providing and ensuring accurate, complete and timely coding of all professional services. All coding staff must ensure accuracy and compliance with all regulatory standards.  

Minimum Job Qualifications

• Licensure or other certifications:

• Educational Requirements: High School Diploma

• Minimum Experience: Minimum two (2) years' experience coding Multi-Specialty records

• Other: High school diploma / GED Accepted

Preferred Job Qualifications

• Preferred Licensure or other certifications: CPC Coding Certification

• Preferred Educational Requirements:

• Preferred Experience:

• Other:

Job Specific and Unique Knowledge, Skills and Abilities

• Detailed knowledge of ICD-9, CPT and HCPCS coding principles and medical terminology

• In-depth knowledge of Optimal coding policy and procedures 

• Highly skilled proficiency with Microsoft Office products

• Ability to communicate (both verbally and written) technical coding information to both technical and non-technical audiences

• Ability to organize data and provide detailed reporting

• Ability to prepare presentations and present to large or small audiences

• Must be highly motivated, detail oriented individual

• Excellent written and oral communication skills

• Problem solving and analytical skills

• Ability to be a self starter/work independently and as a team player

• Ability to travel to NGHS/NGPG sites as needed

• Understanding of current regulatory and third party requirements 

• Accuracy and attention to detail required

• Strong organizational and communication skills

• Positive work ethic with proactive and team-oriented style

Essential Tasks and Responsibilities

• Perform timely, concurrent quality review of coded medical records.

• Correct errors identified in the quality process in both EMR and PMS systems.

• Maintain coding quality statistics and provide detailed reporting to management.

• Communicate error to the Posting, Clinicians and AR staff on an individual basis.

• Communicate to management any problem areas identified in the quality process and steps taken to resolve.

• Assist with the review and correction of coding errors in the billing process (TM queues).

• Assist with the review and correction of coding errors in the electronic claims process (clearinghouse on-line errors).

•  Promptly and professionally respond to both verbal and written coding questions from the internal staff and other areas of the company.

• Review documentation deficiencies for accuracy and communicate identified errors to the coding staff and management.

• Prepare documentation audits as needed for on-site physician education.

• Production coding of medical records as per business needs.

• Adherence to Coding policy and procedures.

• Review charge slips/cards for completeness (providers are ultimately responsible for codes they assign).

• Attends Regional and Local sponsored in-services and/or continuing education.

• Participates in professional development activities and maintains professional affiliations as necessary.

• Provide and/or validate CPT, ICD-9-CM and HCPCS coding of professional services for outpatient clinics, outreach offices or programs, minor diagnostic procedures, and/or ancillary services. 

• Review charge tickets for missing or inaccurate information. Items reviewed include service and diagnosis codes units of service, modifiers, facility code, place of service, provider billing numbers, etc.  

• Communicate with providers and clinic staff to ensure charge capture of all professional services, supplies, drugs, vaccinations, etc. 

• Monitor reconciliation procedures to ensure all charges are captured and billed in a timely manner.

• Research and correct claims manager edits in a timely manner by applying coding and carrier specific guidelines while maintaining compliance initiatives.

• Provide coding coverage to other specialties, departments, divisions, and/or units as required.

• Attend billing educational sessions to enhance coding knowledge i.e. American Academy of Professional Coders, Professional Medical Coding Curriculum, NGPG Compliance Proficiency training, specialty seminars.

• Performs other job duties as assigned.

• Cross trains in other positions as requested.

Physical Demands

• Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time

• Weight Carried: Up to 20 lbs, Occasionally 0-30% of time

• Vision: Moderate, Frequently 31-65% of time

• Kneeling/Stooping/Bending: Occasionally 0-30%

• Standing/Walking: Occasionally 0-30%

• Pushing/Pulling: Occasionally 0-30%

• Intensity of Work: Frequently 31-65%

• Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding

Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals. 

NGHS: Opportunities start here.

Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.