Quality Assurance Specialist

3 days ago

New York, New York, United States RWJBarnabas Health Full time
Job Title: Quality Officer I

Job Summary:

The Quality Officer I is responsible for ensuring the accuracy and integrity of ICD-10-CM/PCS coding and DRG assignment for inpatient encounters. This role requires critical thinking and a skill set above what is expected as a coder. The Quality Officer must sustain an excellent organizational average accuracy rate and adhere to applicable Federal and State Regulations, Compliance Guidelines, and Coding Guidelines set forth by RWJBH, AHA, and AMA.

Responsibilities:
  • Ensures the accuracy and integrity of ICD-10-CM/PCS coding and DRG assignment for inpatient encounters.
  • 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 RWJBarnabas facilities.
  • Reviews ICD-10-CM/PCS coding and DRG assignment of medical records as flagged by SMART.
  • 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.
  • Sustains an excellent organizational average accuracy rate by leveraging advanced knowledge of coding practices leading to exceptional results.
  • 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 RWJBarnabas facilities when appropriate.
  • Reviews Present on Admission (POA) indicators for all diagnosis coded and entered by coders for accuracy and completeness.
  • Independently reports problems with any and all computer system to RWJBarnabas IT&S or SMART helpdesk for resolution.
  • Maintains proper computer and written records of all review activity.
  • Effectively communicates coding recommendations and rationale to Coding team.
  • Performs regulatory coding research as needed.
Requirements:
  • 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.
  • 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.
  • Certifications and Licenses: CCS required, ICD-10-CM/PCS proficiency required.
  • Preferred: CPC-H, RHIT, RHIA, and/or RN also encouraged.
Additional Information:

RWJBarnabas Health is an Equal Opportunity Employer.

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