Job Opportunities


Coding Quality Control & Training Manager

Start Date: December 1, 2023Contract to HireColumbia, South Carolina

The Coding Quality Control Analyst Manager is a leadership position that reports directly to the Assistant Director of coding. This position functions in a management role, with primary responsibility for the overall operation of the Quality Control Coding review team and the Coding Trainer. Monitors the standard of quality and production of work are met or exceed service requirements of patient encounters referred to the coding team. Assures company and client standards are maintained and the integrity of client services are preserved.  The Coding Quality Control Analyst Manager will perform a variety of functions including, but not limited to: conducting audit reviews of quality control staff for accuracy on edits; reporting summary and detailed review data on findings and trends; supports the Coding Team in the development, planning, and execution of the quality review processes.  This is an advanced to expert level coding position.

Responsibility Core Competency
Oversees daily coding quality control review team and coding trainer to ensure quality remains at or above 95% accuracy for the coding team both onshore and offshore.
Works with internal senior management, representatives, and Clients as necessary
Directs and coordinates all training activities of quality control analyst and coding trainer engaged in reviews of coding activities
Coordinates and directs Coding Trainer with onboarding of all new hire staff both onshore and offshore
Performs data quality reviews on inpatient/outpatient encounters to validate the ICD-10-CM, ICD-10- PCS, CPT, and HCPCS Level II code and modifier assignments, DRG/APC group appropriateness.  Ensures compliance with all APC and DRG mandates of inpatient and outpatient reporting requirements.
Monitor the assignment of the principal and secondary diagnoses and procedures by thoroughly reviewing all documentation in the medical record utilizing knowledge of anatomy, physiology, medical terminology, and pathology
Oversee monthly quality reviews of implemented policies Ensures that all turnaround times and quality measurements are met
Communicates/coordinates activities with staff and coding leadership to ensure delivery and completion of assignments, projects, and other performance commitments
Recruits and manages staff that performs quality review activities
Utilize online resources to accurately assign codes. Advanced knowledge of researching coding related issues. (i.e. coding clinics, coding guidelines, etc.)
Keeps abreast of coding guidelines and reimbursement reporting requirements.
Demonstrates competency in the use of computer applications and APC/DRG Grouper Software, Outpatient code edits (OCE), and all coding and abstracting software and hardware currently used by the team and the Client.
Identifies areas of weakness and communicates recommendations on changes and improvement to Assistant Director, Manager and Team Leads and Coding teams. Identifies problems, analyzes cause and effect, and suggests recommendations for improvement.
Documents findings of analysis. Prepares reports and suggest recommendations of implementation of new systems, procedures, or organizational changes.
Relies on specific instructions and pre-established guidelines to perform the functions of the job.
Possesses ability to be confidential; Supports company compliance by demonstrating adherence to all relevant compliance policies and procedures; demonstrates knowledge of HIPAA Privacy and Security Regulations as evidenced by appropriate handling of sensitive information.
Consults and collaborates with Quality Control Analyst, Coding Manager, Coding Team Leads and coding trainer to identify and assess training needs based on work audited.
Participates in quality control meetings with the Coding Leadership
Possesses considerable leadership skills, fostering an atmosphere of trust; seeks diverse views to encourage improvement and innovation; coaches and develops staff through timely and meaningful written feedback.
Possesses a cooperative and positive attitude toward management and co-workers by responding politely and professionally and being a valued team player.
Exemplifies extensive knowledge of the hospital revenue cycle with specialization in healthcare billing, follow-up, and the account resolution process to include, but not limited to: claims submission, acceptance, and adjudication, transaction reviews, adjustment posting, identification of patient responsibility, abstract production coding etc.
Other duties as assigned.
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Recruiting Solutions provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Recruiting Solutions complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities.

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