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Outpatient Coding & Data Quality Manager

Outpatient Coding & Data Quality Manager

QualCode, Inc.

Introduction:

Overview: Manage and coordinate the daily activities of outpatient coding staff and auditors under the direction of the Director of Coding & Data Quality to ensure accurate coding and reporting of clinical data. Audit medical record data and clinical documentation to ensure its accuracy, completeness, validity and consistency. Will perform duties assigned consistent with QualCode’s commitment to providing quality services in a manner that exceeds expectations.

Job Description:

Essential Duties and Responsibilities:

  • Oversee and perform a wide range of activities pertaining to the review and coding of outpatient medical record information.
  • Establish, implement and maintain a formalized monthly/quarterly review process for ensuring 95% coding and validation accuracy within the company; use tools to monitor the accuracy of clinical coding.
  • Perform data quality reviews on a sample (5-10%) of coded outpatient encounters by staff to ensure compliance with federal, state and third party payer coding and reporting requirements; arrange for education and/or corrective action based upon results.
  • Continuously evaluates the quality of clinical documentation to identify incomplete or inconsistent documentation for outpatient encounters that impact the code selection and resulting payment. Bring identified concerns to the client for resolution.
  • Provides and arranges for up to date and timely education and training of coding staff and other healthcare professionals on new coding guidelines and practices, proper documentation, medical terminology and disease processes.
  • Maintains knowledge of current professional coding certification requirements and promotes recruitment and retention of certified staff in coding positions when possible.
  • 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 staff for violations and reports to the company Director of Coding & Data Quality when areas of concern are identified.
  • Collects and prepares data for reporting on special projects involving outpatient encounter data for clinical evaluation purposes and/or financial impact and profitability.
  • Serve as the company’s representative while attending workshops/seminars/conventions.
  • Communicate any outpatient coding and reporting updates published in third-party payer newsletters/ bulletins and provider manuals to coding staff in an ongoing and timely fashion.
  • Stay informed about transaction code sets, HIPAA requirements, and other future issues impacting the outpatient coding function.
  • Keep abreast of new technology in coding and abstracting software and other forms of automation.
  • Demonstrate competency in the use of electronic medical record applications, APC Grouper Software, OCE edits, and all coding and abstracting software and hardware currently in use by the client.
  • Report to President/CEO of QualCode on quality and productivity metrics on a monthly basis.

Required Qualifications:

Experience/Education Requirements:

  • Associate’s degree in health information management or a related field;
  • Credentialed as RHIA, RHIT, CCS, CPC or COC by AHMA and/or AAPC;
  • Minimum of five years progressive coding or coding review experience in ICD-10-CM and CPT/HCPCS with claims processing data management responsibilities a plus;
  • Strong knowledge of the Outpatient Prospective Payment System and regulatory requirements for coding and reporting outpatient services.

Compensation/Benefits:

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

Instructions for Resume Submission:

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

Director of Coding & Data Quality

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

Remote DRG Validator

Remote DRG Validator

QualCode, Inc.

Introduction:

QualCode, Inc. is currently seeking an experienced Remote DRG Validator to join their team in New York, NY.

About Us: For over 15 years QualCode has been providing medical coding, coding education and compliance auditing services for healthcare providers to maximize their revenue while keeping them in compliance with federal and state regulations.

We offer flexible onsite and remote services to help our clients eliminate coding backlogs, reduce RAC exposure, recover lost revenue through DRG/coding and compliance audits and boost efficiency with expert staff training and coding education services.

Job Description:

  • Perform remote review of selected inpatient discharges from Client’s editing program for DRG validation purposes utilizing Client’s encoder software, clinical information system and abstracting system
  • Perform a comprehensive review of the inpatient discharges to confirm:
  • Correct principal diagnosis selection and to check if co-existing diagnoses exist during the time of the admission
  • Appropriate secondary diagnoses including, but not limited to, complications, co-morbidities, and major CC’s
  • Correct procedure code(s) selection
  • Proper sequencing
  • Accuracy of Hospital Acquired Condition (HAC) code
  • Severity of Illness (SOI) and Risk of Mortality (ROM) classification validation
  • Present On Admission (POA) indicator
  • Correct discharge status
  • Perform the review based on AHA Coding Clinic for ICD-10-CM guidelines, CMS ICD-10-CM and ICD-10-PCS Official Guidelines for Coding and Reporting, and Uniform Hospital Discharge Data Set definitions
  • Assess if the clinical documentation supports the diagnoses and procedure codes reported
  • Enter coding changes found into internal database tracking system
  • Release all change discharges in Client’s abstracting system and/or DRG editing system
  • Display a positive attitude within the organization in support of the organization’s programs and mission
  • Promotes effective working relations and works effectively as part of a department/unit team to facilitate goals and objectives
  • Maintains confidentiality of all hospital and patient information (HIM duty)


Education and Experience:

  • High School diploma or equivalent
  • RHIA, RHIT, CCS or CPC credential
  • 3 – 5 years’ of inpatient coding and DRG validation experience in an acute care setting


Skills and Abilities:

  • Extensive knowledge of AHA coding guidelines and ICD-10-CM/PCS coding system
  • Knowledge of MS-DRG, NYS-APR, and NYS-AP-DRG grouper logic, and CMS regulations is required
  • Strong analytical and communication skills with attention to detail
  • Ability to work independently under minimal supervision
  • PC proficient, having a functional knowledge of facility EMR, encoder, and other support software

Compensation/Benefits:

  • $95,000 – $100,000; commensurate with experience
  • Medical/Dental/Vision
  • 401K Plan
  • Paid Time Off (PTO)

Instructions for Resume Submission:

Please submit your resume via email to Thomas Sanders tsanders@qualcodeinc.com