Quality Assurance
2 weeks ago
Quality Assurance (QA) Auditor
Position Summary
At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews. Under the direction of the Director of DRG Quality and Education and collaboration with the DRG Validation Educator and Trainer, the QA Auditor will be a subject matter expert relating to inpatient coding and reporting, conduct quality assurance audits, assist with onboarding new staff members or vendors, assist with and/or conduct educational sessions (1:1 or in a group setting) as well be assigned to other tasks as needed.
Responsibilities
• 75%: QA Audit Reviews
• Analyze and audit inpatient claims following the Official Coding and Reporting Guidelines to validate the reported ICD-10-CM/PCS codes to ensure proper DRG assignment for accurate billing.
• Conduct monthly or quarterly quality assurance audits for onboarding and existing team members.
• Conducted focused audits or ad-hoc audits, as needed.
• 15%: Education Content Creation and Delivery
• Trend and analyze the audit findings to determine educational needs.
• Assists with creation and presentation of ongoing coder education.
• 5%: Subject Matter Expert and General Tasks
• Act as a Subject Matter Expert (SME) for all coders within the department.
• Assist with development and research of coding targets for selection purposes.
• Demonstrates the ability to participate in ongoing department projects.
• Ability to prioritize and organize workload and complete tasks independently.
• Required attendance of all departmental team meetings and/or training.
• Work on other duties or tasks, as necessary.
• 5%: Onboarding
• Collaborates with the DRG Validation Educator and Trainer to assist with onboarding of new hires.
• Assist with QA review of onboarding claims (retrospective and/or live production), 1:1 meeting to answer any questions or review previously reviewed claims. Performance Expectations
• Report productivity daily utilizing department productivity report.
• Meet/exceed productivity expectations as outlined in the department productivity policy.
• Complies with organization policy and procedures.
Qualifications
• Coding Certification required (at least one of the following is required and must be maintained as a condition of employment).
• Registered Health Information Administrator (RHIA)
• Registered Heath Information Technician (RHIT)
• Certified Coding Specialist (CCS)
• Certified Inpatient Coder (CIC)
• Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP) or Certified Professional Coder (CPC) will be considered but will need to obtain an inpatient coding certification (CCS or CIC) within 12 months of hire.
• Registered Nurse (RN) with at least one of the above coding certifications
• College level courses in medical terminology, anatomy, pathophysiology, pharmacology, and medical coding courses.
• Requires 5+ years of experience in MS-DRG and APR-DRG coding experience through acute care inpatient coding, auditing, and/or payment integrity DRG Validation.
• Experience in education and/or training of coding staff preferred.
• Adherence to the Official Coding and Reporting guidelines, AHA Coding Clinic determinations, and CMS and other regulatory compliance guidelines and mandates.
• Requires working knowledge of applicable industry-based standards.
• Proficiency in Outlook, Word, Excel, and other applications.
• Excellent written and verbal communication skills.
• Maintain professional credentialed status with approved continuing education programs.
• Ability to work independently and can multi-task or transition to different tasks easily. Remote Work Requirements
• High speed internet (100 Mbps per person recommended) with secured WIFI.
• A dedicated workspace with minimal interruptions to protect PHI and HIPAA information.
• Must be able to sit and use a computer keyboard for extended periods of time.
Benefits and perks include:
- Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents.
- 401(k) with Employer Match - Join the team and we will invest in your future
- Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays.
- Wellness - We care about your well-being. From Commuter Benefits to FSAs we’ve got you covered.
- Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional.
Salary:90k-105k
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