The Inpatient Coding Quality Reviewer will be responsible for reviewing inpatient coded cases for coding completeness and accuracy. This person will identify potential coding and DRG errors, researches appropriate guidelines to support recommended changes, and communicates the changes to the coder involved on a timely basis. The Reviewer provides expert coding advice to coding staff and relays needed coding educational topics to the Regional Manager, IP Coding Quality.
This role will report to the Regional Manager of Inpatient Coding Quality. In this role, the successful candidate will conduct daily pre-bill review of cases flagged by the PwC SMART coding quality monitoring software tool, maintain required productivity standards and high-quality results.
Responsibilities
Audits records as defined in the coding quality review plan.
Review cases flagged by the coding quality software on a daily basis for multiple hospitals, including validating the completeness of documentation, identifying diagnoses and procedures that have been missed, proposing physician queries, and ensuring the accuracy of diagnoses, procedures, POA, discharge disposition and DRG assignment.
Perform retrospective coding quality reviews as requested.
Follows, and maintains up-to-date knowledge of, industry coding and documentation guidelines (e.g., Official ICD-10 Coding and Billing Guidelines, Coding Clinic advice, R1 and Ascension coding policies and procedures, and AHIMA/ACDIS Query Guidelines) so as to maintain system-wide coding consistency and remain in compliance with governmental and other regulatory guidelines.
Communicates audit findings with coders in a timely manner and supports the teams in effectively and efficiently addressing and resolving local coding issues.
Maintains both a high productivity rate and a high accuracy rate in accordance with established auditing standards.
Serves as an inpatient coding expert & resource for the coding teams and other departments.
Works with the Regional Manager to identify areas of educational need based on audit results.
Reports to, and works with, the Regional Manager to identify improvements in the audit software tool, workflow processes and flag management; and assist with evaluation and testing of audit applications and updates as needed.
Work with the hospital’s CDI team to address and resolve documentation issues. Assists with compilation, generation and analysis of data for results reporting and performance Improvement initiatives.
Contributes to the reduction of the hospital's and Company’s coding compliance risks and contributes to the Company’s revenue enhancement goals.
Maintains an open dialogue and a good working relationship with team members in order to advance the mission and objectives of the hospitals and R1.
Assists with training of new auditors. Assists with other audits and duties as requested.
Required Qualifications:
Associates Degree with CCS credential is required.
A minimum of seven (7) years of hospital inpatient coding experience is required.
Extensive knowledge of ICD-10-CM/PCS classification system and MS- DRG and APR-DRG methodologies is required. In-depth knowledge of medical terminology, human anatomy/physiology, pharmacology, and pathology is required.
Expert and up-to-date knowledge of industry Official Coding and Reporting Guidelines along with CMS and other agency directives for ICD-10 coding.
Must have proficient MS Office computer skills, specifically in Excel and knowledge of various coding software/platforms and EMRs.
Must be detail-oriented and have the ability to work independently and maintain a high productivity rate and coding accuracy rate.
Ability to interact with other employees through effective communication Must be a self-starter.
Desired Qualifications:
Two (2) years of inpatient coding audit experience is preferred.
Experience in a large (> 500 beds) hospital or multi-hospital health system is preferred. Training in hospital Clinical Documentation Improvement is preferred.
Experience as a Coding Consultant with a consulting firm is preferred.
For this US-based position, the base pay range is $26.26 - $38.50 per hour . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career.
Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a competitive benefits package.
R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.
If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.
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To learn more, visit: R1RCM.com
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