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Quality Review Analyst
JOB_REQUIREMENTS
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Required qualifications:
5+ years’ experience auditing Inpatient & Outpatient records
Inpatient MUST be CCS
Outpatient MUST have CCS, CPC or CPC-H
Preferred qualifications:
System experience with EPIC / Meditech / Cerner / Power Chart / Quantum / 3M / TruCode / Paragon / HPF etc…
This position requires an excellent understanding of anatomy, physiology, medical terminology and disease processes. Possess PC skills in keyboarding and applications, audit and/or training experience preferred.
Description:
The Quality Review Analyst ensures that coding specialists are well-trained and up-to-date on rapidly changing regulatory requirements affecting coding compliance and reimbursement issues. The analyst ensures coding data integrity, accuracy and timeliness of completed records. The analyst must maintain an up-to-date knowledge of all coding rules and guidelines and serves as a liaison coding operations. The analyst is responsible for ongoing and continuous monitoring of the quality of all coded data, performing focused audits on all coders as needed and ensuring that the minimum client required accuracy rate is maintained. Essential Functions and Responsibilities:
- Audits each coder’s work ensuring accuracy and compliance
- Ensures compliance with all regulatory coding standards
- Ensures timely submission of all coded accounts
- Researches outstanding accounts and works to ensure completion
- Trains and orients new coders to the team as needed
- Review and maintain results, document trends and interpret performance data to recommend, develop and deliver education and training programs for coding staff
- Educates coders on LCD/NCDs, CDI and other regulatory guidelines
- Communicate verbally and in written form regarding the quality of work performed by individual coders
- Demonstrate excellent customer service, expert coding knowledge, professionalism, effective decision-making, problem solving skills, adaptability, teamwork and mutual respect
- All other duties, as assigned
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