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