Internal Coding Auditor (Quality Assurance Specialist)
Job Type Full-time Description Accuity 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 six years, we have experienced rapid growth and are excited to continue in growing our team nationwide.
Learn more about us at 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 official coding guidelines and client facility specific coding guidelines.
Primary Job ResponsibilitiesPerforms IP coding quality assurance (QA) reviewsMaintains turnaround time expectations to minimize impact to client DNFBMaintains an up-to-date working knowledge of MS-DRG, APR-DRG, ICD-10 CM/PCS codingIdentifies, applies, and validates the use of current industry standard clinical indicators, risk factors and treatment protocols/order sets used in clinical validation of payment impacting code assignmentAbstracts and performs 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 codingReview scope includes validation of the MS-DRGs and APR-DRGs assigned for Medicare, Medicaid, commercial, and third-party claimsRecognizes when a clinical documentation query is necessaryWrites 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 requirementsQuery request writing ability requires knowledge of different types of queries and compliant query practices including knowledge and application of clinical validation criteriaDevelops and maintains a strong understanding of Accuity and of client specific technology, policy, procedures, guidelines, and workflowsEnsures strict confidentiality of patient informationAccountable for meeting or exceeding both production and quality expectationsMeets or exceeds short-term and long-term goals as established for the departmentMay require schedule flexibility and change to accommodate workflow and client business needsParticipates in staff meetings and attends other meetings and seminars as required Requirements Education:
Associates degree required, Bachelor's or Master's degree preferred
Experience:
Minimum 5 years of hospital inpatient coding and/or inpatient clinical documentation improvement experience requiredMinimum 2 years code/DRG auditing experience preferredExperience with electronic health records and health information systems as well as different encodersGovernment program integrity experience preferredDemonstrated knowledge of MS and APR-DRGsDemonstrated knowledge of all applicable coding clinics as they relate to current IP coding practicesLicensure and/or Credentials/certifications (not required)Health information management and/or coding credential from AHIMA and/or AAPC required (RHIA, RHIT, CCS, and/or CIC)CCDS or CDIP certification preferredClinical license preferred (e.
g.
, LPN, RN, BSN, NP, PA, MD, DO, allied health)AHIMA ICD-10/PCS trainer certification preferredKnowledge, Skills, and Abilities:
Expert knowledge of Official Coding Guidelines, advanced knowledge of APR and MS DRG reimbursement models, state, and federal regulationsICD-10-CM/PCS coding expertise including POA assignment and discharge disposition codesKnowledge 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 categoriesKnowledge of quality assurance/healthcare internal auditing concepts and principlesSolid command of anatomy, physiology, pathology, laboratory, imaging, pharmacology, disease assessment, patient management, and treatmentKnowledge of legal, regulatory, and policy compliance issues related to medical coding and documentationKnowledge of current and developing issues and trends in medical coding diagnosis and procedure code assignmentAdvanced knowledge of medical coding, electronic medical record systems, and coding systemsAbility to use independent judgment and to manage confidential informationAbility to analyze and problem solveDetail oriented with ability to multi-taskStrong communication (written and oral) and interpersonal skillsAbility to clearly communicate information to coders, physicians, and CDI staffAbility to provide guidance and training to Accuity coding, physician, and CDI staffIndependent, focused individual who takes initiative and can work remotelyAble to execute under the pressure of time constraints and maintain focus over period of work hoursDemonstrates ability to work independently as well as cooperatively with various teamsServes as a professional role model for internal and external customersCertifications and/or professional license must be maintained as a condition of employmentMaintains 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 employmentAbility to use a PC in a Windows environment, including MS Office applicationsIndependent, focused individual able to work remotely or on-site Recommended Skills Anatomy Attention To Detail Auditing Business Requirements Certified Coding Specialist Claim Processing Estimated Salary: $20 to $28 per hour based on qualifications.
Over the last six years, we have experienced rapid growth and are excited to continue in growing our team nationwide.
Learn more about us at 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 official coding guidelines and client facility specific coding guidelines.
Primary Job ResponsibilitiesPerforms IP coding quality assurance (QA) reviewsMaintains turnaround time expectations to minimize impact to client DNFBMaintains an up-to-date working knowledge of MS-DRG, APR-DRG, ICD-10 CM/PCS codingIdentifies, applies, and validates the use of current industry standard clinical indicators, risk factors and treatment protocols/order sets used in clinical validation of payment impacting code assignmentAbstracts and performs 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 codingReview scope includes validation of the MS-DRGs and APR-DRGs assigned for Medicare, Medicaid, commercial, and third-party claimsRecognizes when a clinical documentation query is necessaryWrites 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 requirementsQuery request writing ability requires knowledge of different types of queries and compliant query practices including knowledge and application of clinical validation criteriaDevelops and maintains a strong understanding of Accuity and of client specific technology, policy, procedures, guidelines, and workflowsEnsures strict confidentiality of patient informationAccountable for meeting or exceeding both production and quality expectationsMeets or exceeds short-term and long-term goals as established for the departmentMay require schedule flexibility and change to accommodate workflow and client business needsParticipates in staff meetings and attends other meetings and seminars as required Requirements Education:
Associates degree required, Bachelor's or Master's degree preferred
Experience:
Minimum 5 years of hospital inpatient coding and/or inpatient clinical documentation improvement experience requiredMinimum 2 years code/DRG auditing experience preferredExperience with electronic health records and health information systems as well as different encodersGovernment program integrity experience preferredDemonstrated knowledge of MS and APR-DRGsDemonstrated knowledge of all applicable coding clinics as they relate to current IP coding practicesLicensure and/or Credentials/certifications (not required)Health information management and/or coding credential from AHIMA and/or AAPC required (RHIA, RHIT, CCS, and/or CIC)CCDS or CDIP certification preferredClinical license preferred (e.
g.
, LPN, RN, BSN, NP, PA, MD, DO, allied health)AHIMA ICD-10/PCS trainer certification preferredKnowledge, Skills, and Abilities:
Expert knowledge of Official Coding Guidelines, advanced knowledge of APR and MS DRG reimbursement models, state, and federal regulationsICD-10-CM/PCS coding expertise including POA assignment and discharge disposition codesKnowledge 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 categoriesKnowledge of quality assurance/healthcare internal auditing concepts and principlesSolid command of anatomy, physiology, pathology, laboratory, imaging, pharmacology, disease assessment, patient management, and treatmentKnowledge of legal, regulatory, and policy compliance issues related to medical coding and documentationKnowledge of current and developing issues and trends in medical coding diagnosis and procedure code assignmentAdvanced knowledge of medical coding, electronic medical record systems, and coding systemsAbility to use independent judgment and to manage confidential informationAbility to analyze and problem solveDetail oriented with ability to multi-taskStrong communication (written and oral) and interpersonal skillsAbility to clearly communicate information to coders, physicians, and CDI staffAbility to provide guidance and training to Accuity coding, physician, and CDI staffIndependent, focused individual who takes initiative and can work remotelyAble to execute under the pressure of time constraints and maintain focus over period of work hoursDemonstrates ability to work independently as well as cooperatively with various teamsServes as a professional role model for internal and external customersCertifications and/or professional license must be maintained as a condition of employmentMaintains 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 employmentAbility to use a PC in a Windows environment, including MS Office applicationsIndependent, focused individual able to work remotely or on-site Recommended Skills Anatomy Attention To Detail Auditing Business Requirements Certified Coding Specialist Claim Processing Estimated Salary: $20 to $28 per hour based on qualifications.
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