Coding Quality Review Specialist -Inpatient

General Summary of Position
The Inpatient Coding Quality Review Specialist is responsible for providing expert review to ensure the quality and integrity of medical records. Responsibility includes validating ICD-10-CM/PCS codes by examining medical record documentation the assignment of present on admission (POA) indicators and discharge disposition status. Also responsible for reviewing Quality indicators which include MHACs, HACs, PSIs and Mortality reviews.

Primary Duties and Responsibilities

• Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
• 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.
• Participates in multi-disciplinary quality and service improvement teams

Minimal Qualifications
Education

• High School Diploma or GED required
• 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

• 1-2 years inpatient coding experience, preferably in an acute care setting required
• 3-4 years Auditing experience preferred

Licenses and Certifications

• AHIMA (American Health Information Management Association) CCS required
• Certificate as a Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) or Certified Inpatient Coder (CIC AAPC) preferred

Knowledge Skills and Abilities

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