Quality Control Coding Analyst
The Virtual Business Office is currently seeking an experienced Coding Quality Control Analyst to join our award winning healthcare revenue cycle extended business office team. We provide revenue cycle business office solutions for our clients nationwide, and have been ranked #1 in KLAS for Extended Business Office Services for 6 consecutive years. If you are looking to join a winning team and industry leader in revenue cycle management, this is the position for you! The Coding Quality Control Analyst conducts quality control audits of patient encounters referred to the Virtual Business Office and assures company and client standards are maintained and the integrity of client services are preserved. The Coding Quality Control Analyst will perform a variety of functions including, but not limited to: conducting audit reviews of coding staff for accuracy on edits; reporting summary and detailed audit data on findings and trends; and, supporting the Coding Team in the development, planning, and execution of the auditing processes.
This role consults with and takes direction from the Quality Control and Coding teams to resolve quality and efficiency issues that may occur on any given project. This is an advanced to expert level coding position.
- 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.
- 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.
- 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.
- Identifies problems, analyzes cause and effect, and suggests recommendations for improvement.
- Identifies areas of weakness and communicates recommendations on changes and improvement to Quality Control and Coding teams.
- Documents findings of analysis. May prepare 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 and Coding Team Leads to identify and assess training needs based on work audited.
- Participates in quality control meetings.
- 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, etc.
- Other duties as assigned.
Required Knowledge and Skills:
- Current AHIMA credentials (i.e. CCS, CCS-P) or AAPC credentials (i.e. COC, CIC, CPC, CPC-H) required and maintained
- Demonstrate advanced to expert level coding competency in ICD-10-CM, ICD-10-PCS, CPT-4, HCPCS and Coding Modifiers and displays advanced competency of Inpatient/Outpatient coding guidelines and Diagnosis Related Group (DRG)/Ambulatory Payment Category (APC) assignment
- Able to document problems and assist in their resolution.
- Proven ability to lead by example and foster mentoring relationships.
- Strong written and oral communication skills. Computer and internet literate in an MS Office environment.
Job Requirements and Preferences:
- Minimum Degree Required: Associates Degree or higher preferred
- Minimum Licensure/Certification: Current AHIMA credentials (i.e. CCS, CCS-P) or AAPC credentials (i.e. COC, CIC, CPC, CPC-H) required and maintained
- Minimum Years of Experience: 7+ years of medical coding experience (facility and/or consulting) to include both inpatient and outpatient, preferably in an acute care setting; 10+ years preferred
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.
Recruiting Solutions expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status.