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The Coding Quality Reviewer shall report directly to the Internal Quality Control Coding Director and will be responsible for accessing and reviewing the medical record documentation, coding and abstracting accuracy as performed by the Guidehouse coding team by utilizing ICD-10 CM/PCS and CPT coding classification systems. Review of patient records will be conducted via facility EMR, scanning technology or other established method. This position will perform any and all related job duties as assigned.
Essential Job Functions
- Computer Literacy
- Excellent verbal and written Communication Skills
- High level of productivity
- HIPAA compliant work stations
- Advanced Coding Skills, ICD-10-CM/PCS and CPT
- Strong knowledge of governmental regulations relating to coding
- Ability to work independently
- Strong working knowledge of Protected Health Information
Duties and Responsibilities
- Ensure 3-5% coding quality review (or percentage stipulated in client contract) of each coder’s work is conducted monthly for those facilities the reviewer is assigned.
- Coding quality review will be conducted to identify abstracting (to include dc disposition and POA indicators), ICD-10-CM, ICD-10-PCS, CPT, modifier, and HCPCS coding errors for codes assigned by the coding team (see quality review policies for review details).
- Reviewer will run coder productivity reports (where applicable) to pull random sample accounts for review and to ensure review percentages are met per facility contract.
- Review coding and abstracting on all patient types assigned (may include the following): inpatient, ambulatory surgery, observation, emergency room, clinic, ancillary, diagnostics, etc to assure 95% coder accuracy (or as stipulated by client contract).
- Become familiar with any facility specific coding guidelines and know where to access on the Navigant portal.
- Required to read all Coding Clinics and CPT Assistant updates and stay abreast of all new coding guidelines.
- Ensure code recommendations are supported with AHA Coding guidelines, Coding Clinics, CPT Assistant and/or other official coding references. Reviewers will also document the specific record documentation that supports any code recommendation.
- Perform chart reviews and coding recommendation notifications to coding team in a timely manner (same day review conducted).
- Enter review findings in a timely manner for each account reviewed into NAVaudit software daily or at a minimum within 24 hours of review.
- Communicates in a professional, non-threatening mentorship manner with the coding team in coding quality recommendation discussions.
- Follows review escalation policy when coder/review disagreements occur (see quality review policy/procedures).
- Notify Director and VP of Quality when coding risk areas and error trends are identified for a specific facility and/or coder.
- Assist Coders in answering coding/abstracting questions resulting from the quality reviews.
- Reviews monthly and quarterly coder quality reports and performs intensification reviews for Coders who fall below the stipulated accuracy rate as part of the corrective action plan.
- Maintain a working knowledge of ICD-10-CM/PCS and CPT coding principles, governmental regulations, official coding guidelines, and third party requirements regarding documentation and billing.
- Ability to maintain average review productivity standards as follows: Inpatients 2 charts per/hr, outpatient surgery 3-4 charts per/hr, emergency room/clinics 11 charts per/hr, emergency room with E/M 7-8 charts per/hr, ancillary/diagnostic 15 charts per/hr. This excludes outliers.
- Complete review activity summary daily (productivity summary) for each facility and submit to IQC Manager and VP of Quality on a weekly basis (utilized to calculate quality review FTEs assigned to each facility).
- Review and be familiar with the annual review criteria standards as well as DRG review calendar.
- Assist as needed in the review of external coding audit company findings and formulates a response to be used in the defense of the codes assigned.
- Participates in client conference calls and mandatory monthly quality team stand-up calls. Responsible to review the minutes of monthly quality stand up calls if not able to dial into the conference call (minutes are posted on the portal).
- Provide company support for the creation, maintenance and ongoing operation of an efficient and accurate Quality Improvement Plan that is compliant with Local, State, and Federal Government Regulations.
- Work with the Coding Solutions Division to provide on-going coding education resulting from the Quality Reviews. This will involve direct one-on-one correspondence between the coder and reviewer.
- Maintain open lines of communication serving as a liaison between client, Coders, and Coding Solutions Division to insure that all parties are kept up to date on specific hospital guidelines/policies.
- Participate in company Coding Solutions Division Meetings as requested.
- Reviewer must be able to work independently while maintaining specific productivity standards.
- Basic computer skills are needed to handle connection issues, downloads and to review specific programs.
- Reviewer downtime must be reported immediately to the IQC Manager/Director immediately to ensure adequate work flow.
- Facility access system problems should be reported to administrative HIM team, facility IT and Navigant help desk immediately.
- Reviewers are responsible for checking and responding to Guidehouse email system at the beginning of their shift, at least every two hours during the review session and at the end of their shift, These same requirements apply to the client secure email system.
- Reviewers must maintain their current professional credentials while working for Navigant.
- Reviewers are responsible for maintaining HIPAA compliant work stations (reference HIPAA work station policy).
- Reviewers are responsible for maintaining patient privacy at all times (reference company handbook policy).
- Reviewers are responsible for signing a confidentiality statement.
- It is the responsibility of each reviewer to review and adhere to the coding division policy and procedure manual content.
- Works well with other members of the facilities coding and billing team to insure maximum efficiency and reimbursement for properly documented services.
- Communication in emails should be professional and collaborative at all times (reference e-mail policy).
- Must hold one of the following credentials: (RHIT, RHIA, CCS, CIC or COC).
- Must maintain coding credential while employed by Guidehouse.
- Must pass Guidehouse coding competency exam.
- Must have three years of coding or review experience.
- Abide by all client policies and procedures.
- Abide by all Guidehouse policies and procedures.
- Personal responsibility, respect for self and others, innovation through teamwork, dedication to caring and excellence in customer service.
Information System Requirements:
- Computer and monitors provided by Guidehouse.
- Internet Access with DSL or high-speed connectivity.
- Remote office location that meets HIPAA privacy requirements.
- Strong conceptual, as well as quantitative and qualitative analytical skills
- Work as a member of a team as well as be a self-motivator with ability to work independently
- Constantly operates a computer and other office equipment to coordinate work
- Regularly uses close visual acuity and operates computer equipment to prepare and analyze and transmit data
- Generally works in an office environment
The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.
Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.
Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.
If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [Click Here to Email Your Resumé]. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.
Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.
Rewards and Benefits
Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.