Quality specialist Jobs in Scottsdale, AZ

Job Type Full-time Description

POSITION SUMMARY :

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 documentation clarification or confirmation 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
• Performs miscellaneous job-related duties as assigned

Requirements

POSITION QUALIFICATIONS :

Education :

Licensure and / or Credentials / Certifications :

Experience :

Knowledge, Skills, and Abilities :