HIM CODING QUALITY ANALYST - Health Information - Full Time - Days

HIM Coding Quality Analyst - Full Time 

#Corehire

This position is remote, must reside in CA. 

Shift: 7:00am - 3:30pm

Job Description:

PATIENT POPULATION:
The patient population served can be all patients, including geriatric, adult, adolescent, pediatric, and newborn. This also includes services which affect facility staff, physicians, visitors, vendors and the general public.

POSITION SUMMARY:
Under the supervision of the Director of Health Information Management (HIM), the HIM Coding Quality Analyst will perform coding quality audits of inpatient and outpatient records to ensure appropriateness and accurate code assignments in accordance with Center of Medicare and Medicaid (CMS) guidelines and to provide ongoing feedback and analysis of the educational needs of the coding staff.

Must be able to work normal/scheduled working hours to include Holidays, call-backs, weeknights, weekends, and on-call. Agrees to participate, as directed, in emergencies and community disasters during scheduled and unscheduled hours. As a designated disaster service worker you are required to assist in times of need pursuant to the California Emergency Services Act.
(Gov’t. Code §§ 3100, 3102)

Needs to recognize that they have an affirmative duty and responsibility for reporting perceived misconduct, including actual or potential violations of laws, regulations, policies, procedures, or this organization’s standards/code of conduct.

The employee shall work well under pressure, meet multiple and sometimes competing deadlines; and the incumbent shall at all times demonstrate cooperative behavior with colleagues and supervisors.


EDUCATION/TRAINING/EXPERIENCE:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

To perform this job successfully, an individual should be a high school graduate or equivalent. Must have extensive knowledge of federal, state and payer-specific regulations and policies pertaining to documentation, coding and billing. Must have the ability to analyze and identify opportunities for documentation improvement. Knowledge of medical terminology, anatomy and physiology, CPT, ICD (9 and 10), HCPCS coding, and Medicare and Medicaid (CMS) regulations is also required. Must have a minimum of 5 years of coding experience in an acute care facility using ICD-9-CM and CPT/DRG assignment and 1 year coding auditing (or equivalent) experience.

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence if required. Ability to work with physicians in a collaborative manner.

Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages if required.

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. Effective time management skills to permit working in a fast-paced, results-oriented environment. Detail oriented.

To perform this job successfully, an individual should have demonstrated data entry skills. Type 40-50 wpm. Computer terminal experience and basic working knowledge of commonly used business software (including but not limited to Microsoft Office, Word, Excel and e-mail).


LICENSURE/CERTIFICATIONS:
Must hold one or more of the approved coding certifications (i.e., Certified Coding Specialist (CCS), Certified Coding Specialist – Physician Based (CCS-P), Certified Professional Coder (CPC), or equivalent approved certification).

Responsibilities and Essential Functions:
*Indicates Essential Function

1 * Performs on-going quality assessments to monitor accuracy of code assignment, sequencing, POA and DRG assignments for quarterly coding quality monitoring by auditing a minimum of charts required in the Coding Compliance Program (CCP) per coder per quarter.
2 * Routinely performs pre-bill review of 25 records on new coders. Performs pre-bill review of additional 10 records if the new coder's accuracy rate is below 95%.
3 * Assist coders with initiation of physician queries when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes and follows query process for medical records filing.
4 * A