Internal Coding Auditor (Quality Assurance Specialist)
Company: Accuity
Location: Little Rock
Posted on: May 25, 2023
Job Description:
Job Type
Full-time
Description
Accuity was founded in 2016 with the goal of reinventing the
Clinical Documentation Process through MD case review, and MD to MD
education. Over the last six years, we have experienced rapid
growth and are excited to continue in growing our team nationwide.
Learn more about us at www.accuityhealthcare.com
The Quality Assurance (QA) Specialist is responsible for
performance of internal coding QA reviews. These reviews provide an
additional layer of internal coding quality and compliance of
inpatient (IP) records to assure appropriateness and accuracy of
code assignments in accordance with official coding guidelines and
client facility specific coding guidelines.
Primary Job Responsibilities
- Performs IP coding quality assurance (QA) reviews
- Maintains turnaround time expectations to minimize impact to
client DNFB
- Maintains an up-to-date working knowledge of MS-DRG, APR-DRG,
ICD-10 CM/PCS coding
- Identifies, applies, and validates the use of current industry
standard clinical indicators, risk factors and treatment
protocols/order sets used in clinical validation of payment
impacting code assignment
- Abstracts and performs a comprehensive review of the medical
record to assess the documentation present/absent as it compares to
the base code set impacting payment, or a requested change in
coding
- Review scope includes validation of the MS-DRGs and APR-DRGs
assigned for Medicare, Medicaid, commercial, and third-party
claims
- Recognizes when a clinical documentation query is
necessary
- Writes a query ask with clinical indicators and/or
documentation excerpts if a discrepancy or gap exists in the
medical record documentation and the (base, desired) code
assignment per application of Official Coding Guidelines, or if a
medical condition does not appear to be clinically supported or
meeting clinical criteria requirements
- Query request writing ability requires knowledge of different
types of queries and compliant query practices including knowledge
and application of clinical validation criteria
- Develops and maintains a strong understanding of Accuity and of
client specific technology, policy, procedures, guidelines, and
workflows
- Ensures strict confidentiality of patient information
- Accountable for meeting or exceeding both production and
quality expectations
- Meets or exceeds short-term and long-term goals as established
for the department
- May require schedule flexibility and change to accommodate
workflow and client business needs
- Participates in staff meetings and attends other meetings and
seminars as required
Requirements
Education:
- Associates degree required, Bachelor's or Master's degree
preferredExperience:
- Minimum 5 years of hospital inpatient coding and/or inpatient
clinical documentation improvement experience required
- Minimum 2 years code/DRG auditing experience preferred
- Experience with electronic health records and health
information systems as well as different encoders
- Government program integrity experience preferred
- Demonstrated knowledge of MS and APR-DRGs
- Demonstrated knowledge of all applicable coding clinics as they
relate to current IP coding practices
Licensure and/or Credentials/certifications (not required)
- Health information management and/or coding credential from
AHIMA and/or AAPC required (RHIA, RHIT, CCS, and/or CIC)
- CCDS or CDIP certification preferred
- Clinical license preferred (e.g., LPN, RN, BSN, NP, PA, MD, DO,
allied health)
- AHIMA ICD-10/PCS trainer certification preferredKnowledge,
Skills, and Abilities:
- Expert knowledge of Official Coding Guidelines, advanced
knowledge of APR and MS DRG reimbursement models, state, and
federal regulations
- ICD-10-CM/PCS coding expertise including POA assignment and
discharge disposition codes
- Knowledge of AHRQ Quality Metrics including patient safety
indicators (PSIs), Hospital Acquired Conditions (HACs), Vizient
Mortality Models, CMS Core Measures, other national patient safety
quality indicators, and different payor categories
- Knowledge of quality assurance/healthcare internal auditing
concepts and principles
- Solid command of anatomy, physiology, pathology, laboratory,
imaging, pharmacology, disease assessment, patient management, and
treatment
- Knowledge of legal, regulatory, and policy compliance issues
related to medical coding and documentation
- Knowledge of current and developing issues and trends in
medical coding diagnosis and procedure code assignment
- Advanced knowledge of medical coding, electronic medical record
systems, and coding systems
- Ability to use independent judgment and to manage confidential
information
- Ability to analyze and problem solve
- Detail oriented with ability to multi-task
- Strong communication (written and oral) and interpersonal
skills
- Ability to clearly communicate information to coders,
physicians, and CDI staff
- Ability to provide guidance and training to Accuity coding,
physician, and CDI staff
- Independent, focused individual who takes initiative and can
work remotely
- Able to execute under the pressure of time constraints and
maintain focus over period of work hours
- Demonstrates ability to work independently as well as
cooperatively with various teams
- Serves as a professional role model for internal and external
customers
- Certifications and/or professional license must be maintained
as a condition of employment
- Maintains subject matter expertise in clinical validation
criteria and practices, ICD-10-CM/PCS code sets, coding guidelines,
clinical documentation integrity, and inpatient payment
methodologies as a condition of employment
- Ability to use a PC in a Windows environment, including MS
Office applications
- Independent, focused individual able to work remotely or
on-site
Keywords: Accuity, Little Rock , Internal Coding Auditor (Quality Assurance Specialist), Accounting, Auditing , Little Rock, Arkansas
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