Virtual Coding Quality Review Team Lead in Nashville, TN at Parallon

Date Posted: 4/15/2018

Job Snapshot

Job Description

The Coding Quality Review (CQR) Team Lead may assist with selecting and assigning coding samples for review, reviewing medical records, and compiling and reporting out review results. The lead may assist with providing coder specific education and global coding education based on review findings and trends. The lead may be asked to perform coding quality reviews up periodically. 

Duties Include But Are Not Limited to:



  • Assists CQR Management with account review selection and assignments as needed
  • Assists CQR Management with monitoring workflow and providing status updates of team and reviews
  • Assists the Coding Quality Reviewers (CQRs) with the processes pertaining to reviews including but not limited to onboarding and training
  • Assists CQR Management with analyzing the coding review data and identifying HSC, coder, and code/DRG error trends
  • Assists in  forecasting and review capacity of the CQR team
  • Performs coding quality reviews including appeal escalation and communication of the account outcomes to CQRs, HSC and CQR Management as needed
  • Manages outcomes from Internal Audit reviews on the CQRs including communicating review results, responding to appeals, completion of action plans, and monitoring the rebill process with the HSCs
  • Analyzes CQR Outcomes, trends High Risk areas, and creates action plans for CQRs
  • Maintains CQR Team Scorecards
  • Analyzes HSC Review Outcomes, trends High Risk areas
  • Creates Quarterly Toolkits for HSCs and conducts follow up and action plans
  • Provides direct oversight of the rebill processes
  • Performs environmental scanning for quality review initiatives
  • Performs internal quality reviews on CQRs and reporting to CQR Management
  • Assists in coaching and mentoring CQRs to reach productivity and quality goals
  • Maintains or exceeds productivity standards
  • Maintains or exceeds 95% coding accuracy
  • Reports to CQR Management periodically on team and individual work accomplishments, problems, progress in mastering tasks and work processes, and individual and team training needs
  • Reviews all official data quality standards, coding guidelines, company policies and procedures, and clinical/medical resources to assure coding knowledge and skills remain current
  • Assists in compiling and reporting Coding Quality Review Outcomes to CQR Management
  • Supports all CQR team related systems and tools
  • Provides oversight of coding compliance related tools
  • Acts as the Subject Matter Expert to assist with development, testing and maintenance  of such tools



Job Requirements

KNOWLEDGE, SKILLS & ABILITIES



  • Coding Technical/Professional Knowledge and Skills - extensive regulatory coding (ICD-9-CM, ICD-10-CM, ICD-10-PCS, CPT-4, Modifiers, MS-DRGs, POA assignment and where applicable APR-DRGs) 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
  • Adaptability to major changes in work responsibilities or environment; adjusting effectively to work within new work structures, processes, requirements, or cultures
  • Initiative - independently takes prompt proactive steps toward problem resolution
  • Contributing to Team Success by actively participating as a member of the team to move the team toward the completion goals
  • Work Standards- setting high standards of performance for self and others; assuming responsibility and accountability for successfully completing assignments or tasks; self-imposing standards of excellence rather than having standards imposed
  • 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
  • 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 in a Remote Environment– 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 preferred
  • Equivalent work experience may substitute degree requirement 



EXPERIENCE



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



 

CERTIFICATE/LICENSE



  • RHIA, RHIT and/or CCS preferred