Director of Coding & Data Quality

QualCode, Inc.

Introduction:

The Director of Coding and Data Quality is responsible for developing, implementing, and maintaining a data quality management (compliance) plan for coding and reimbursement, clinical documentation improvement, and quality data in the company. Will perform duties assigned consistent with QualCode’s commitment to providing quality services in a manner that exceeds expectations.

Job Description:

  • Develop, implement, maintain, and update annually a standardized, quality data management (compliance) plan and program to ensure compliance with coding guidelines.
  • Develop, implement, maintain , and update accordingly standardized company policies and procedures to monitor the success of the quality data management plan, review areas of risk, investigate identified issues, report data analyses, and take appropriate steps to correct deviations.
  • Establish, implement, and maintain a formalized monthly/quarterly review process for ensuring 95% coding and validation accuracy within the company.
  • Performs data quality reviews on inpatient and outpatient encounters to validate the coding and reimbursement and compliance with all reporting requirements.
  • Provides and/or arranges for quarterly training of coding professionals on new coding guidelines and practices, documentation improvement opportunities, compliant query practices, disease processes, new medical technology appropriate to the job description and function as it relates to the coding, clinical documentation and other data quality management factors.
  • Maintains knowledge of current professional coding certification requirements and promotes recruitment and retention of certified staff in coding and validation positions when possible.
  • Serves as the company representative for coding and data quality by attending coding and reimbursement workshops and brings back information for education of staff. Communicates any coding and reimbursement updates published in third-party payer newsletter and bulletins and provider manuals to all staff.
  • Keeps abreast of new technology in coding and abstracting software and other forms of automation and stays informed about transaction code sets, HIPPA requirements and other future issues impacting the coding and validation function.
  • Demonstrates competency in the use of computer applications and DRG Grouper Software, APC Grouper Software, Medicare edits and all coding and abstracting software and hardware currently in use by various clients.
  • Reports quality and productivity metrics on monthly basis to company President/CEO
    Communicates, cooperates and works effectively with clients. Serves as resource to coding and validation staff on coding guidelines and practices.
  • Demonstrates a high degree of initiative and problem-solving ability. Accepts and carries out job responsibilities.
  • Abide by the standards of American Health Information Management Association (AHIMA) Standards of Ethical Coding and the American Academy of Professional Coders (AAPC) Code of Ethics and monitors coding and validation staff for violations and reports to the company President/CEO when areas of concern are identified.

Required Qualifications:

  • At least 10 years of professional experience, 5 of which are in data quality; or a master’s degree or its equivalent and at least 7 years of experience in a clinical, operational, or data quality improvement function
  • Experience in operational management
  • Experience in project management
  • Knowledge of health information systems and database management
  • Strong knowledge of the Inpatient and Outpatient Prospective Payment System and regulatory requirements for coding and reporting inpatient and outpatient services
  • Knowledge of applied statistics, process analysis and outcomes analysis


Preferred Qualifications:
Education Qualifications:

  • Bachelor’s degree in health information management or a related field
  • Credentialed as an RHIA, or RHIT, and CCS

Compensation/Benefits:

  • Medical/Dental/Vision
  • 401K Plan
  • Paid Time Off (PTO)

Instructions for Resume Submission:

To apply, please submit your resume to Ivore Robinson: irobinson@qualcodeinc.com