Quality Improvement Coordinator (QIC) - IP (1099 Role)

Pena4; United States; On-site; USD 65,000 - 100,000; Part time

Job summary

Pena4 seeks a Quality Reviewer to ensure accuracy and integrity of ICD-10-CM/PCS coding and DRG assignment for inpatient encounters across payer sources. This role demands critical thinking and a skill set above a standard coder, with strict adherence to applicable regulations and client guidelines.

The Quality Reviewer will manage SMART queues, review EPIC SMART WQ’s, and direct coders with precise recommendations.

Qualifications

• 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 without a Bachelor’s degree.
• CCS, ICD-10-CM/PCS proficiency required; CPC-H, RHIT, RHIA and/or RN encouraged.
• Extensive knowledge of ICD-10-CM/PCS and CPT coding; medical terminology and anatomy.

Responsibilities

• Ensure accuracy of ICD-10-CM/PCS coding and DRG assignment.
• Critically analyze inpatient records for coding, DRG judgments, SOI, ROM and POA.
• Manage SMART queues for all acute care facilities.
• Direct coders with case-specific recommendations and provide education.
• Coach coders on coding principles, assignments and sequencing with clear documentation.
• Maintain records of review activity and communicate recommendations to Coding team.
• May perform other related duties.

Skills

Critical thinking

Communication

Time management

Independence

Coaching/education

Team collaboration

Education

Bachelor’s degree or equivalent

CCS

CPC-H

RHIT

RHIA

RN

Tools

3M Coding & Reimbursement

Citrix

EPIC

SMART Software

Job description

The Quality Reviewer 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 Reviewers must also sustain an excellent organizational average accuracy rate. Adherence to applicable Federal and State Regulations, Compliance Guidelines, and Coding Guidelines set forth by the client, American Hospital Association (AHA) and the American Medical Association (AMA) must be maintained.

Position Responsibilities may Include:

• 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 facilities at assigned client. 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 Reviewers to ensure a unified methodology within the 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.
• Productivity Standards must be met for all Quality Reviewers.
• Independently monitors SMART queues to ensure all records imported by SMART are reviewed and properly directed, with/or without coding or other recommendations, or released to billing as appropriate and within department accepted timelines.
• Reviews Discharge Status, Admission and Discharge Dates, and other related demographic information coded and entered by affiliate staff for accuracy and completeness. Communicates the need for Case Management review to the facilities when appropriate.
• Reviews Present on Admission (POA) indicators for all diagnosis coded and entered by coders for accuracy and completeness.
• Maintains proper computer and written records of all review activity.
• Effectively communicates coding recommendations and rationale to Coding team.
• May be required to perform other related duties.

Education/Experience

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. CCS required; ICD-I0-CM/PCS proficiency required; CPC-H, RHIT, RHIA and/or RN also encouraged.

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.

Special Equipment/Skills

Must be able to utilize a personal computer with Windows and Microsoft Office software. Must be able to utilize the 3M Coding and Reimbursement program, Citrix, EPIC and SMART Software systems.

Job Types: Part-time, Contract, Temporary