Inpatient Coding Quality Officer Payer

Job Title:

Inpatient Coding Quality Officer I - (All Other Payer)

Location:

Barnabas Health Corp

Department: HIM - Coding Quality

Req#:

Status:
Full-Time

Shift: Day

Pay Range: $75,597.00 - $ Annual

The above reflects the anticipated annual salary range for this position if hired to work in New Jersey.

The compensation offered to the candidate selected for the position will depend on several factors, including the candidate's educational background, skills and professional experience.

The Quality Officer 1 is responsible for ensuring accuracy and integrity of ICD-10-CM/PCS coding and DRG assignment for inpatient encounters for other payers (not Medicare/Managed Medicare). This requires critical thinking and a skill set above what is expected as a coder. Quality Officers must also sustain an excellent organizational average accuracy rate. Adherence to applicable Federal and State Regulations, Compliance Guidelines, and Coding Guidelines set forth by RWJBH, American Hospital Association (AHA) and the American Medical Association (AMA) must be maintained.

Required:

• Bachelor s degree or equivalent in experience.
  • 4+ years acute care coding and/or auditing experience with a Bachelor s degree.
  • 7+ years acute coding and/or auditing experience required without a Bachelor s degree.
• Extensive knowledge of ICD-10-CM/PCS and CPT coding, medical terminology, human anatomy and physiology, clinical indicators associated with disease processes and pharmacology is required
• Knowledge of billing and coding regulations.
• Must have excellent interpersonal, oral, and written communication skills. Must be capable of critical thinking and analysis and written conveyance of same.
• Must have excellent organizational and time management skills.
• Must maintain a professional demeanor .
• Must be able to work independently and cooperatively with minimal supervision.
• Must foster positive relationships with fellow co-workers and the coding team.

• CCS required
• ICD-I0-CM/PCS proficiency required.

• CPC-H, RHIT, RHIA and/or RN also encouraged.

• Position is primarily remote with occasional onsite requirement.

• Ensures the accuracy and integrity of ICD-10-CM/PCS, CPT coding when applicable and DRG assignment for adherence to Federal and State Regulations and Compliance Guidelines.
• Critically analyzes each inpatient medical record to apply appropriate coding, DRG judgements, SOI, ROM and POA.
• Independently manages SMART pending queues for all acute care RWJBarnabas facilities. Reviews ICD-10-CM/PCS coding and DRG assignment of medical records as flagged by SMART.
• Independently manages EPIC SMART WQ s to assure proper workflow of identified accounts.
• Directs coders with appropriate case-specific recommendations. Educates and coaches coders in the application of coding principles, code assignment and sequencing, DRG assignment and clinical disease processes. Coding advice must be clearly and concisely written with appropriate clinical indicators cited. Additional facilities that may join the System receive the same education and coaching from the Quality Officers to ensure a unified methodology within the RWJBH organization.
  
  This results in improved outcomes in DRG assignment, coder education and DNB lag time within all facilities.
• Sustains an excellent organizational average accuracy rate by leveraging advanced knowledge of coding practices leading to exceptional results.
• The Quality Officer s coding analysis is reviewed by the Coding Specialists on a biannual basis. The consequences of incorrect judgments affecting the DRG may include an increased monitoring, until quality scores of 90% or better for two consecutive months are obtained. The consequences of incorrect coding resulting in erroneous DRGs includes under reporting and/or over reporting. Incorrect coding may result in an incorrect reporting of diagnoses and procedures to the patient s EHR which may affect the patient s future care, insurance claims and coverage.
  
  When accounts are not reviewed and released in a timely manner, there is a detrimental impact to the reimbursement flow…