Quality Improvement Coordinator (QIC) - IP and OP Medical Coding

Position Purpose

To provide on-going quality assurance activities for respectively assigned client engagements in order to ensure the highest level of coding quality of company resources.

Position Summary

Responsible for performing coding quality improvement and oversight for coding and data quality engagements by assessing coding accuracy and to maintain internal and client-specific accuracy requirements. QIC is responsible for coordinating quality management efforts including development, implementation, education, data collection and analysis.

The QI Coordinator is also responsible for providing consulting services and acting as subject matter expert to existing and new clients. Consultant may be required to perform consulting services remotely, to ensure billable hours are generated for the company. The set goal is to generate revenue equal to 1 (one) times annual salary, by performing billable hours for clients, or through referrals which lead to new contracts and additional revenue equal to 1 (one) times annual salary.

Essential Job Requirements

Education : Associate degree required; Bachelor degree preferred

Experience : Minimum of 5-7 years of H.I.M. and coding experience, with at least 5 years of coding quality assurance experience (auditing), IP and OP Coding and Auditing experience.

Credentials / Certifications : CCS and / or RHIA / RHIT required. Additional credentials (CPMA, CCS-P, CPC, COC, CIC, or CRC) are preferred.

Required Skills :

Advanced knowledge and performance of ICD-10-CM / PCS coding, CPT coding, HCPCS coding, MS-DRGs, APR- DRG’s, APCs, HCCs, POAs, HACs, medical terminology, and pharmacology.

Advanced knowledge of documentation standards and improvement methodologies.

Strong Proficiency in auditing concepts, principles, statistics, and reporting.

Knowledge and use of grouper and encoder systems, 3M / Nuance Clintegrity preferred.

Knowledge and use of EMRs, Epic / Powerchart preferred

Strong Proficiency in ICD-10 CM / PCS, CPT coding, MS-DRG, APRDRG chart auditing.

Strong organizational, analytical, and problem-solving abilities and techniques with excellent communication and interpersonal skills.

Ability to work independently in a remote environment.

Preferred Skills : Strong Proficiency in MS Office. (Word, Excel, PowerPoint)

Productivity Standards : 15-18 IP cases per 8-hour shift. 25-30 OP cases per 8 hour shift.

Position Responsibilities

Ensure that coding services to clients adhere to the AHA Official Coding Guidelines, Coding Clinics, CPT Assistants, UHDDS definitions, and AHIMA and CMS standards of ethical coding.

Reviews medical record documentation to ensure that coding staff perform services according to the policies and procedures of the client (except when in conflict with official coding guidelines), and that coding and abstracting is complete and accurate using ICD-10-CM and ICD-10-PCS coding classification systems.

Conduct data quality assessments of coding resources for respective accounts and compiles report findings to management and clients as appropriate.

Conduct root cause analysis (RCA) of audit findings to identify coding / documentation error trends.

Translate RCA outcomes into targeted corrective action plans and follow up with coders to ensure improvements.

Ensure accountability by monitoring completion of corrective actions tied to RCA results.

Serve as subject matter expert for the coding processes and guidelines related to respective assigned accounts, proactively identify trends and training requirements. Partner with the education team to develop training materials (tip sheets, coding refreshers, coding clinics) based on RCA findings.

Develop and maintain documentation related to quality improvement activities, including policies procedures, reports and Client-Specific Coding Guidelines for respective client engagements.

Track coder performance month-over-month post-education to confirm sustained improvements in accuracy.

Provide support to clients, consultants & employees as related to coding, abstracting and data quality for respective accounts.

Provide monthly summaries of trends / errors to Coding Leadership for oversight and escalate concerns to the respective Team Lead and / or production management team, and Coding and Quality Improvement management team for resolution as necessary.

Facilitate communication across Coding, CDI, Billing and Customer Support teams on error trends and resolutions.

Assist management with planning, designing, implementing, and maintaining a comprehensive medical practice continuous quality improvement (CQI) program including utilization management and risk management.

Evaluate variances and other data to identify QI opportunities and risk management issues.

Keep abreast of coding guidelines and reimbursement reporting requirements and maintain coding credential requirements. Stay up to date on industry best practices and emerging trends in quality management.

Perform ICD-10 diagnosis / procedure and / or CPT coding for hospital-based inpatient and / or outpatient cases, within scope of expertise.

Perform / assist in inpatient and / or outpatient data quality reviews and audits as necessary, within scope of expertise.

Assists in the development and delivery of coding educational sessions for assigned client engagements as per the contractual commitment, or as requested.

Achieve and maintain a monthly coding accuracy and MS-DRG / APC accuracy rate of 95% or above.

Act as consultant and subject matter expert for existing and new clients

Perform consulting services for clients remotely, to ensure billable hours are generated for the company

Generate revenue equal to 1 (one) times annual salary, by performing billable hours for clients, or through referrals which lead to new contracts and additional revenue

Assist in other related projects as necessary.

Limitations and Disclaimer

The above job description is meant to describe the general nature and level of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required for the position.

All job requirements are subject to possible modification to reasonably accommodate individuals with disabilities. Some requirements may exclude individuals who pose a direct threat or significant risk to the health and safety of themselves or other employees.

This job description in no way states or implies that these are the only duties to be performed by the employee occupying this position. Employees will be required to follow any other job-related instructions and to perform other job-related duties requested by their supervisor in compliance with Federal and State Laws.

Requirements are representative of minimum levels of knowledge, skills and / or abilities. To perform this job successfully, the employee must possess the abilities or aptitudes to perform each duty proficiently. Continued employment remains on an “at-will” basis.

Job Type : Full-time

Work Location : Remote