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Virtual Coding Quality Assurance Team Lead in Nashville at Parallon

Date Posted: 12/7/2018

Job Snapshot

Job Description



The Coding Quality Assurance Team Lead is responsible for assisting in the development and implementation of Central Coding Resource Management (CCRM) coding Quality Assurance process.  The Team Lead performs quality reviews of vendor code/DRG/abstracting assignments as well as compilation and reporting of results to enhance quality outcomes. The Lead prepares and provides coder specific education based on audit outcomes and trends. The Lead also assists the CCRM Manager with vendor management including answering coding questions and account follow up/resolution.

Duties (included but not limited to):

  • Assists CCRM Manager in the review and improvement of processes and services
  • Prepares and presents  coder education  and orientation in conjunction with CCRM Manager
  • Assists CCRM Manager in capturing, analyzing, and trending  quality data
  • Assists CCRM Manager in ensuring  global vendor staff adhere with coding guidelines and policies
  • Performs quality reviews of inpatient and/or outpatient records as needed; Where applicable, validates ICD-10-CM, ICD-10-PCS, CPT/HCPCS level II Codes as well as facility E/M levels and  injection/infusion procedure codes assigned by global vendor coders
  • Validates accuracy of codes assigned by CAC (Computer Assisted Coding) tool; assists in monitoring coders CAC adoption behavior; assists in identifying precision and recall improvement opportunities
  • Monitors coder performance metrics and precision & recall rate for CAC; and works with the vendors when improvements are needed
  • Monitors and assists the vendors in the monthly random, focus,  prebill, and various Ad Hoc quality audit process
  • Performs quality reviews of physician queries in compliance with company policy and Regs query handbook
  • Assists in reviewing errors or workflow concerns raised by the Health Information Management Service Centers (HSC) and follows up with the vendors as appropriate
  • Communicates as appropriate with the global vendor staff and all HSCs to ensure proper account resolution
  • Develops and presents coding education on the identified high risk areas.
  • Assists with preparation and maintenance of Quality review logs
  • Maintains or exceeds 95% coding review accuracy
  • Initiates quality reviews of physician queries in compliance with Company and HSC policy where appropriate


Job Requirements

KNOWLEDGE, SKILLS & ABILITIES

  • Coding Technical skills - extensive regulatory coding (ICD-9-CM, CPT-4, MS-DRGs, POA Assignment and where applicable APR-DRGs and PPCs) and associated reimbursement knowledge
  • Case Mix Index Analytical skills - ability to analyze trends in CMI and determine root cause and address as appropriate
  • Effective Decision Making - relating and comparing; securing relevant information and identifying key issues; committing to an action after developing alternative courses of action that take into consideration resources, constraints, and organizational values
  • Initiative - independently takes prompt proactive steps toward problem resolution
  • Organization - establishing courses of action to ensure that work is completed efficiently; proactively prioritizes assignments and keen ability to multi-task
  • Communication – communicates professionally, clearly, proactively, and concisely with all key stakeholders, both individually and in group settings
  • Leadership - guides individuals and groups toward desired outcomes
  • Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations
  • Policies &Procedures – articulates knowledge and understanding of organization policies, procedures and systems
  • PC Skills – skilled in all Microsoft Office applications
  • Quality Orientation – accomplishing tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time
  • Work independently – is self-supporting; not needing to rely on others to complete a job
  • Building and Maintaining Strategic Working Relationships – develops collaborative relationships to facilitate the accomplishment of work goals. Possesses good interpersonal skills in building, negotiating, and maintaining crucial relationships
  • Managing conflict – dealing effectively with others in an antagonistic situation; using appropriate interpersonal styles and methods to reduce tension or conflict between two or more people
  • Mentor and Educate – provides timely guidance and feedback to help strengthen the knowledge/skill set of others to accomplish a task or solve a problem


 
EDUCATION

  • Undergraduate degree in HIM/HIT required or equivalent work experience
  • Equivalent work experience may substitute degree requirement




EXPERIENCE

  • Management/Supervisory experience in healthcare related field preferred
  • Minimum of 5 years acute care inpatient/outpatient coding experience required
  • Minimum of 3 years coding auditing/monitoring experience strongly preferred


 
CERTIFICATE/LICENSE

  • RHIA, RHIT and/or CCS required