Coding Quality Specialist
Position Purpose
The Coding Quality Coordinator II is the journey level position within a job series that performs complex reviews of clinical documentation on inpatient and outpatient medical records. Validates accuracy of diagnostic and procedural coding, payment methodology, and reimbursement amount; develops written rationale of findings; responds to providers for resolution of appeals.
Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.
- Performs complex review of physician clinical documentation on inpatient and outpatient medical records.
- Performs quality analysis to determine accuracy of diagnostic and procedural coding, the correct interpretation and application of official coding guidelines and rules, and assignment of appropriate codes.
- Determines correct payment methodology and reimbursement.
- Develops case-specific written rationale to substantiate and communicate findings to hospital, provider, medical director, and peer review team.
- Conducts coding re-review for decisions that are based on coding convention and sequencing guidelines, not requiring medical review.
- Identifies clinical questions and refers cases to Medical Director.
- Responds to providers for resolution of appeals.
- Reviews updates to Coding Clinics, coding newsletters, and other professional resources to maintain up-to-date knowledge.
- Participates in ongoing in-service programs for coding-related or clinical education.
- Identifies and interprets patterns of possible fraud or abuse and refers to appropriate party for further evaluation and corrective action.
- Conducts periodic peer reviews.
- Other duties as assigned.
- Performs other duties as assigned.
- Complies with all policies and standards.
Education/Experience
Not included in the source posting: about the role, what you'll do, benefits.
Who can apply
The employer didn't state any visa, work authorization, citizenship or clearance requirements in this posting. Confirm with the employer before applying.
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