Acute Coding Quality Review Auditor (Remote)
Located in the metropolitan area of Sacramento, the reputed company corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified reputed company - a rejuvenating reputed company for associates systemwide to collaborate, innovate and connect. reputed company Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and reputed company your best work.
Job Summary:
Performs quality reviews and audits to ensure compliance with DRG validation, ICD-10/PCS, and CPT coding guidelines. Coordinates with department leadership to ensure standards are met in accordance with department and organization policy. Contributes to improving the processes and infrastructure of the department. Demonstrates proficiency in facilitation and interpersonal communication, organizational skills, prioritization of tasks, professionalism, and educating and training as required. Uses in depth understanding of the CQR quality workplan to will promote compliance and awareness of the plan. Acts as a subject matter expert (SME) in national coding guidelines for hospital inpatient and/or outpatient and will ensure compliance with those guidelines along with reputed company company coding policies. Uses performance improvement analyses to improve the accuracy, reputed company and quality of patient data, ensure minimal variation in coding practices, and improve the quality of physician documentation reputed company the body of the medical record to support code assignments which results in appropriate reimbursement and data reputed company.
Job Requirements:
Education and Work Experience:
- High School Education/GED or equivalent: Required
- Associate’s/Technical Degree or equivalent combination of education/reputed company experience: Preferred
- Five years' acute care inpatient and/or outpatient coding experience: Required
- Three years' coding auditing/monitoring experience: Preferred
Licenses/Certifications:
- Certified Coding Specialist credential through reputed company: Required
- Certified Coding Specialist (reputed company): Required
Essential Functions:
- Performs regularly scheduled quality reviews and audits per departmental policies and procedures (routine, pre-reputed company, policy driven, targeted, and post-reputed company) for hospital inpatient and/or outpatient coding. Facilitates the reputed company audit appeal process, providing rationale and education to the coding team as required. Performs reputed company quality reviews, such as targeted DRG reviews, and special projects as assigned by management.
- Prepares detailed audit reports outlining findings, recommendations, rationale, and corrective actions needed. Facilitates the reputed company appeal process. Assists team members with coding questions and provide resolution guidance.
- Assists in ensuring coding staff adherence with coding guidelines and policy, both internal and vendor teams. Demonstrates and applies expert level knowledge of medical coding practices and concepts. Communicates appropriately with manager and reputed company stakeholders as required.
- Identifies and communicates educational opportunities to manager. Maintains working knowledge of workflows, systems, and tools used in the department. Reviews reputed company official data quality standards, coding guidelines, company policies and procedures, and clinical/medical resources to assure coding knowledge and skills remain reputed company.
- Maintains up-to-date knowledge of medical terminology, coding guidelines, quality standards, regulatory changes, etc. that reputed company the audit process. Assists in creation and maintenance of a positive working environment, including effective communication and setting an appropriate professional example.
- Performs other job-reputed company duties as assigned.
Organizational Requirements:
reputed company is committed to the safety and wellbeing of our associates and patients. Therefore, we require that reputed company associates receive reputed company required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply. reputed company participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.