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Job Summary
The Coding Quality Review Specialist will be responsible for auditing, reviewing, and validating coding practices to ensure compliance with internal and external standards. This includes ensuring accurate data entry, adherence to coding guidelines, and identifying any discrepancies or errors in the coding process. The role is essential for ensuring that all coding-related activities meet quality standards and comply with industry regulations.
Key Responsibilities
- Review and Audit Codes
- Review healthcare or software development codes for accuracy, consistency, and adherence to applicable coding guidelines and standards (e.g., ICD-10, CPT, HCPCS for healthcare coding or specific coding systems in software development).
- Perform regular audits to ensure the coding team adheres to coding conventions and rules.
- Provide Feedback & Training
- Offer feedback to coding team members regarding areas of improvement.
- Provide ongoing training to coding staff on best practices, updates in coding standards, and industry changes.
- Analyze and Resolve Coding Issues
- Investigate and resolve discrepancies in coding that affect billing, insurance claims, or software performance.
- Ensure proper coding compliance and work with the coding team to address any errors or discrepancies.
- Ensure Compliance
- Stay updated on industry regulations and changes, ensuring that coding practices are compliant with HIPAA, CMS, OIG, and other regulatory bodies (for healthcare).
- Assist in ensuring that all coding practices meet internal audit and external regulatory compliance standards.
- Documentation and Reporting
- Document audit results and track coding quality metrics.
- Prepare and present regular reports on coding accuracy, error rates, and improvement initiatives to management.
- Continuous Improvement
- Work closely with the coding team to promote continuous improvement by identifying opportunities for training, process improvements, and error reduction.
- Participate in the creation and revision of coding policies and procedures.
Qualifications
- Undergraduate degree in HIM/HIT preferred (Associate’s or Bachelor’s)
- RHIA, RHIT and/or mandatory
- IP Coding Auditor for MS-DRG
- Must have experience in all body systems – cannot be specialized in one area i.e., Orthopedic etc.
- Must have 3 years of hands on coding MS-DRG auditing in a hospital setting.
- Cannot be a recent graduate needs experience ideally 10+ years of coding and 3 years of auditing in MS-DRG Inpatient medical records.
We cannot employee candidates who reside in California, Alaska, New York or Colorado for any of our work form home positions
Will be expected to complete a coding test (20 Multiple Choice/True/False 5-7 Open ended Behavioral questions- 90 minutes long