Coding Quality Review Specialist - Inpatient (PRN)

General Summary of Position

Primary Duties and Responsibilities

• Assists with the development of system-specific coding guidelines as needed and participates in Quality review team meetings.
• Uses knowledge of coding compliance plan to direct efforts to achieve plan by focusing on areas identified through coding reviews or targeted by management for improvement.
• Helps select areas for focused quality reviews.
• Maintains continuing education. Maintains credentials for required job classification.
• Meets established Quality Accuracy and Productivity standards as defined by policies.
• Provides/identifies trends to provide feedback to appropriate sources. Identifies and assists in areas to provide additional training/education under the direction of Manager.
• Queries the medical staff and other caregivers as necessary to obtain accurate and complete physician documentation that supports the severity of the patient illness and risk of mortality
• Performs retrospective reviews on coding staff. Reviews analyzes and interprets medical record documentation to identify diagnoses and procedures. Assigns correct ICD 10-CM and ICD 10-PCS codes using standard guidelines and automated encoding software. Assigns the appropriate DRG.
• Works closely with the Coding Quality Review team to identify areas for improvement and problematic cases.

Minimal Qualifications

• Education
• High School Diploma or GED required
• Associate's degree, Vocational/Technical Degree or certificate. Associate in Health Information Management Health Information Technology or similar degree with successful completion of medical terminology Anatomy and Physiology and Coding courses in ICD-10 CM and PCS preferred

Experience

Licenses and Certifications

Knowledge Skills and Abilities

• Excellent verbal and written communication skills.
• Excellent interpersonal skills.
• Strong computer skills preferred.