HIM Cert Coder​/Quality Review Analyst OP

Overview

This position is responsible for timely and accurate quality review of both internal and vendor coding team members to assure compliance with coding guidelines and standards in addition to their foundation coding responsibilities. The position performs quality checks on coding and provides feedback to coders to assure the timely and accurate coding of medical charts for billing. This position also reviews and response to coding-based denials for inpatient, hospital outpatient and professional fee claims and advises leadership on trends related to denials.

In collaboration with HIM coding management, the coder/quality review analyst will assist with selection of coders and encounters to be reviewed, as well as education to be presented to the coder based on review outcomes. The coder/quality review analyst will also bring forward any issues related to documentation or systems as they are discovered during the review process. This position participates in the onboarding process of new coders, which may require intensive audits and reviews until the coder is fully trained and released.

Certifications:

Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC);
Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA);
Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA);
Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA);
Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA);
Certified Professional Coder - Payer (CPC-P) - American Academy of Professional Coders (AAPC);
Certified Professional Coder - Hospital (CPCH) - American Academy of Professional Coders (AAPC),

Education:

High school diploma or G.E.D

Work Experience:

Coding

• Perform accurate and timely quality reviews of internal and vendor coding team members using appropriate code sets and coding guidelines.
• Develop and perform timely coding education to internal and vendor coding team members on coding systems, coding standards, protocols and Carle coding workflow as required based on quality review outcomes.
• Perform as a production coder when needed in a manner aligned with current coding productivity and quality standards.
• Shares results of quality reviews to HIM Leadership with recommendations for education and training.
• Works with HIM leadership to determine frequency and scope of coding quality reviews for specific coders and vendors.
• Compile and track statistics related to the review function, completed quality reviews, and follow up from those reviews.
• Identifies coder training needs, system issues, and/or documentation issues and reports them timely to HIM leadership.
• Review and respond to coding denials and coding questions as requested or assigned and performs clinical validation of appeal letters as needed.
• Assists in editing appeal letters ensuring clinical documentation support and regulatory guidelines are considered.
• Participates in system and new application testing as needed.
• Review and resolve coding-based denials using EPIC WQs or other software. Provide denial trending data to leadership as requested.
• Works with Manager to analyze denied claims and identify trends for education.
• Serves as subject matter expert (SME) for coding denials providing guidance and education to coding staff, physicians and other hospital departments.
• Provides regular reports to management on denial trends, appeal outcomes and overall performance metrics.
• Identifies work types to be reviewed based on the coding scope and new coder onboarding needs of the HIM department.
• Develops and performs HIM coding team member group education on coding topics identified during quality reviews and denial reviews.
• Assist the HIM coding management in assuring all coding performed by HIM or HIM vendors meets department standards.

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