Coding Quality Review Specialist

i4 Search Group; Nashville (TN); Remote; USD 70,000 - 90,000; Full time

Job summary

A healthcare organization seeks a Coding Quality Review Specialist in Nashville. This full-time role focuses on maintaining coding quality through assessments and ensuring compliance with national and internal guidelines. Ideal candidates should possess significant coding experience and relevant certifications in health information management.

Benefits

Work From Home

Qualifications

• Must have 3 years of hands-on coding and MS-DRG auditing experience.
• Ideally, 10+ years of coding experience in inpatient medical records.
• RHIA, RHIT, and/or mandatory certifications are required.

Responsibilities

• Lead and perform quality reviews for inpatient and outpatient coding.
• Ensure adherence to national coding guidelines and policies.
• Participate in special reviews or projects as required.

Skills

Medical coding practices

Quality assessment

Compliance

Education

Undergraduate degree in HIM / HIT

Job description

Coding Quality Review Specialist - Nashville, TN

Full-time

• Work From Home

Job Summary

As a Coding Quality Review (CQR) Specialist, you will operate in a work-from-home environment supporting all CQR team-related systems and tools. You will perform internal quality assessment reviews on Health Information Management Service Center (HSC) coders to ensure compliance with national coding guidelines, HSC coding policies, and company coding policies to ensure complete, accurate, and consistent coding, resulting in appropriate reimbursement and data integrity.

Job Responsibilities

• Lead, coordinate, and perform all functions of quality reviews (routine, pre-bill, policy-driven, and incentive plan-driven) for inpatient and outpatient coding across multiple HSCs.
• Assist in ensuring HSC coding staff adherence to coding guidelines and policies.
• Demonstrate and apply expert-level knowledge of medical coding practices and concepts.
• Participate in special reviews or projects.
• Maintain or exceed 95% productivity standards.
• Maintain or exceed 95% accuracy.
• Meet all educational requirements as stated in current company policy.
• Review all official data quality standards, coding guidelines, company policies and procedures, and clinical/medical resources to ensure coding knowledge and skills remain current.

Qualifications

• Undergraduate degree in HIM / HIT preferred (Associate's or Bachelor's).
• RHIA, RHIT, and/or mandatory certifications.
• Must have experience in all body systems; cannot be specialized in one area (e.g., Orthopedic).
• Must have 3 years of hands-on coding and MS-DRG auditing experience in a hospital setting.
• Ideally, 10+ years of coding experience and 3 years of auditing in MS-DRG inpatient medical records.

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