Coding Quality Auditor & Specialist

Category: Health Care

Location:

The CodingQuality Auditor and Specialist is responsible for assuring coding guidelinesand regulations are not compromised during the decision-making process relatedto clinical documentation and the coding of this documentation.This position partners with ClinicalDocumentation Nurses, Physicians, and other licensed providers to improve thequality of documentation, assuring best quality performance and representationof care provided. In addition, the Coding Quality Auditor and Specialistcollaborates with the CMOs to ensure the integrity of the Health Record isestablished through best practices in Clinical Documentation and Coding.

TheCoding Quality Auditor and Specialist is responsible for maintaining qualitywork queues and quality reports, advanced and complex project work thatincludes but, is not limited to, Risk Adjustment, Mortality Review, HospitalAcquired Condition (HAC) and Patient Safety Indicator (PSI) Review, QualityAbstraction and Analysis, and/or special and non-traditional project work.Incumbents to this role have a mastery of advanced clinical documentationintegrity and quality concepts, coupled with the ability to consistentlyidentify root causes and deliver measurable results. Key to this role is theability to lead and facilitate quality initiatives and external rankingsinitiatives.

TheCoding Quality Auditor and Specialist solves complex problems and adds newperspectives to existing solutions. The Coding Quality Auditor and Specialistapplies advanced knowledge of the national quality agenda and clinicaldocumentation integrity and coding compliance to advance problem analysis andcreative process.

RESPONSIBILITIES

§Collaborates withclinical documentation team in the review of inpatient accounts (with anemphasis on mortality reviews) identifying documentation improvementopportunities

§Assess DRG, PDx,secondary Dx, PCS, POA and all other components of documentation that impactquality metrics

§Consistentlyassures coding practices remain compliant with coding guidelines andregulations

§Continuallyidentifies educational opportunities related to coding and documentation

§Expert educatorto clinical teams, medical staff and inpatient coders

§Identifiesstrategic plans that will result in a positive impact to the clinical dashboard

§Develops clinicalrelationships across the health system securing interdepartmental supportnecessary for successful implementation of education strategies assuringachievement of overall strategic targets

§Ability tomulti-task a variety of audits

§Ability to analyzedata and construct appropriate action plans

§Develops teachingtools to promote quality outcomes

§Is an activemember of clinical and executive meetings as identified

§Advanced understandingof quality metrics for health system (Vizient, PSI, USNWR, LeapFrog, AHRQ, CMS)

§Advancedunderstanding of clinical documentation and coding through the lens of localand national quality and ranking methodologies, including but not limited to,U.S News and World Report, Vizient, Leapfrog, the CMS Star Rating, AHRQ andpayer contracts and assists the Managers of Clinical Documentation and Codingin implementing key strategies to effect change.

§Partners withCoding, Clinical Documentation leadership and Medical Directors to coordinate,maintain, and execute advanced project work that includes but, is not limitedto, Mortality Review, HAC/PSI Review, Quality Abstraction and Analysis, and/orspecial and non-traditional project work.

§Partners with several departments that includes but is not limited to: IT; Analytics; and Innovationto design and implement new and advanced workflow solutions.

§Partners withthird-party consultants/partners to contribute to workflow and methodologybuild and refine as necessary.

Requirements

Required:

• RHIT or RHIA or CCS Certification
  
• Certified Clinical Documentation Specialist(will consider CDIP certification)
  
• Bachelor Degree – Healthcare related(will consider candidate currentlyenrolled in Bachelor program)
  
• Five years of coding experience in area of expertise
  
• Clinical expertise and understanding achieved through prior experience working with clinical documentation teams
  
• Strong personal computer skills (Word, Excel, PowerPoint, Visio)
  
• Excellent verbal, written, and presentation skills
  
• Demonstrates critical thinking skills
  
• Excellent interpersonal skills
  
• Planning and time management skills
  
• Educational/training experience
  

Preferred:

·Master’s Degree in related field orcurrently enrolled in Master’s program

ManagementResponsibility:

• This position will not have direct reports.
  

Benefits

Details

Originally posted on Himalayas