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Coding Quality Analyst

Grand Rapids, Michigan 49503

Job ID: 11517 Category: Technology

Job Description

  • Keeps abreast of coding guidelines and reimbursement reporting requirements.

 

Non-established coder

  • Routinely perform pre-bill review of at least the volume records required for Coding Compliance Program on a new coder (non-established Phase I coder).
  • Routinely performs pre-bill review of at least the volume of records required in the Coding Compliance Program (CCP) on a new coder (non-established coder, Phase II).
  • Performs pre-bill review of additional ten records if the new coder’s (non-established coder, Phase II) accuracy rate is below 95%.
  • Initiates coaching and/or corrective action if new coder’s DRG accuracy rate of 95.00% or higher is not achieved within the 90 day period

 

Established coder

  • Performs on-going quality assessments to monitor accuracy of code assignment, sequencing, POA and DRG assignments for quarterly coding quality monitoring by auditing a minimum of charts required in the CCP per coder per quarter.
  • Recommends Senior CQA initiates coaching and/or corrective action if new coder’s DRG accuracy rate of 95.00% or higher is not achieved within the 90 day period
  • Routinely performs prebill audit for Coders who have a break in production coding or are off for an extended period of time as described in the CCP. Refers Coder to Training & Development Sr. for action plain if less than 95% is achieved, until quality reaches standards as stated in CCP
  • Meets all yearly education requirements and codes inpatient records as needed.
  • Assist coders with initiation of physician queries when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes and follows query process for medical records filing.

 

Leadership:

  • Assists in ensuring coding staff adherence with coding guidelines, manuals and policies
  • Assists Senior Spec, Training & Development in finding specific charts to use for trainee coding education and practice
  • Audits, tracks, trends and communicates to coders of any identified coding errors
  • Proactively communicates the progress of a newly transitioned non-established coder into production coder to the educator in the first 90 days following completion of phase I
  • Routinely respond to any external (Helpline/Epic WQ/Discrepancy Queue) and internal (Messaging Queue) coding inquires with 48hrs
  • Identifies training and educational opportunities and makes recommendations to standardized training and education to the system coders
  • Submit all disputed cases to 3M Nosology and ensure the case log is updated
  • Conducts new Phase II coder orientation and training
  • Openly communicates issues and opportunities to appropriate person(s)
  • Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and American Academy of Professional Coders and adheres to official coding guidelines.
  • Makes determinations on consolidating coded clinical information from multiple registrations or splitting coded information from single admissions based on reporting rules. Advises Billing Department of these determinations.

 

Qualifications:

  • High School Diploma or Equivalent Required
  • Areas of Specialties
    • Opthomology Surgery
    • Dialysis
    • Gastro
    • Osteo
    • Nutrition
    • Plastics
    • AOPI
    • Care Management
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