Job details
Job type full-time
Full job description
About us:
Accuity delivery systems was founded in 2016 with the goal of reinventing the clinical documentation process through md case review, and md to md educationOver the last four years, we have experienced rapid growth and are excited to continue in growing our team nationwideLearn more about us at www.accds.com.
About the position:
The quality assurance (qa) specialist is responsible for performance of internal coding qa reviewsThese 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 center of medicare and medicaid (cms) guidelines and client facility specific coding guidelinesThis position reports to the quality assurance (qa) manager.
Primary responsibilities:
Performs ip coding quality assurance (qa) reviews
Maintains turnaround time expectations to minimize impact to client dnfb
Maintains an up-to-date working knowledge of ms-drg, apr-drg, icd-10 cm/pcs coding clinics
Identify, apply, and validate the use of current industry standard clinical indicators, risk factors and treatment protocols used in clinical validation of payment impacting code assignment
Actively and skillfully conceptualizes, applies, analyzes, synthesizes, and evaluates information gathered from, or generated by observation, experience, reflection, reasoning, or communication as a guide to validate review results/findings and correct, as necessary
Abstracting and performing 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 coding
Review scope includes validation of the ms-drgs and apr-drgs assigned for medicare, medicaid, commercial, and third-party claims
Writing 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 requirements
Documenting the finding and the corrections to be made in a clear and compelling manner along with accurately and concisely providing the supporting evidence from the medical record and/or references; the knowledge and application of effective reconciliation and rebuttal strategies
Develops and maintains a strong understanding of accuity and of client specific technology, policy, procedures, guidelines, and workflows
Ensures strict confidentiality of patient information
Accountable for meeting or exceeding both production and quality expectations
Meets or exceeds short-term and long-term goals as established for the department
May require schedule flexibility and change to accommodate workflow
Participates in staff meetings and attends other meetings and seminars as required
Assist in special projects and other roles and responsibilities as needed to support accuity
Performs miscellaneous job-related duties as assigned
Position qualifications:
Education:
Associates degree in health information management required
Bachelor’s degree or master’s degree in health information management preferred
Clinical license or rhia/rhit with coding credential required from ahima and/or aapc required
Ccds or cdip preferred
Maintains credentials through completion of annual ceu requirements
Experience:
Minimum 5 years of hospital or vendor inpatient coding and/or cdi experience required
Minimum 2 years coding qa experience
Experience with electronic health records and health information systems
Government program integrity experience highly preferred
Certifications and/or professional license must be maintained as a condition of employment
Maintains 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 employment
Demonstrated knowledge of ms and apr-drgs
Demonstrated knowledge of all applicable coding clinics as they relate to current ip coding practices
Knowledge, skills, and abilities:
Icd-10-cm/pcs coding expertise including poa assignment and discharge disposition codes
Expert knowledge of official coding guidelines, advanced knowledge of apr and ms drg reimbursement models, state, and federal regulations
Knowledge 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 categories
Knowledge of quality assurance concepts and principles
Solid command of anatomy, physiology, pathology, laboratory, imaging, pharmacology, disease assessment, patient management, and treatment
Knowledge of legal, regulatory, and policy compliance issues related to medical coding and documentation
Knowledge of current and developing issues and trends in medical coding diagnosis and procedure code assignment
Advanced knowledge of medical coding, electronic medical record systems, and coding systems
Ability to use independent judgment and to manage confidential information
Ability to analyze and problem solve
Detail oriented with ability to multi-task
Strong communication (written and oral) and interpersonal skills
Ability to clearly communicate information to coders, physicians, and cdi staff
Ability to provide guidance and training to accuity coding, physician, and cdi staff
Ability to use a pc in a windows environment, including ms word
Independent, focused individual who takes initiative and is able to work remotely or on-site
Able to execute under the pressure of time constraints and maintain focus over period of work hours
Demonstrates ability to work independently as well as cooperatively with various teams
Serves as a professional role model for internal and external customers
