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Coding Compliance Specialist I

2 months ago

Irving, Texas, United States Christus Health Full time

Overview:

*CHRISTUS Health System is seeking a Coding Quality Assurance Specialist I for a remote position. Candidates must reside in specific states to be considered for this role.*

The Coding Quality Assurance Specialist is responsible for conducting internal coding assessments to support the operational needs of the Coding Department. This role plays a vital part in enhancing coding education and training while facilitating pre-bill and cross-training initiatives to maintain and elevate the skill set of our coding associates.

This position requires a comprehensive understanding of current coding standards, including ICD-10-CM, ICD-10-PCS, and CPT/HCPCS guidelines, with a focus on achieving a minimum accuracy rate of 95%.

Responsibilities will vary based on departmental requirements and may include PEPPER reviews, new hire assessments, standard pre-bill evaluations, remediation processes, performance improvement assessments, query quality reviews, and other specialized evaluations as necessary. The Coding Quality Assurance Specialist will assess quality concerning POA assignments, diagnosis code accuracy, procedural coding, modifier application, discharge disposition verification, query opportunities, and DRG and APC accuracy.

This role will involve collaboration with various departments within CHRISTUS Health, including Regional Coding Managers, HIM, Compliance, and Clinical Documentation Specialists, to ensure effective feedback is communicated for educational and training purposes. The Coding Quality Assurance Specialist may also assist with production coding to maintain current skills and adapt to evolving technologies and workflows.

The Coding Quality Assurance Specialist will report directly to the HIM Coding Education Manager, with additional guidance from the Director of Coding Operations and the System HIM Director.

Key Responsibilities:

  • Meet the expectations outlined in the OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
  • Conduct inpatient and outpatient coding assessments.
  • Communicate findings effectively, both verbally and in writing, in an approved format to support training and education initiatives.
  • Assist in developing and coordinating review plans, providing feedback to coding staff and management regarding query opportunities, documentation improvements, accurate code assignments (ICD, CPT, HCPCS), payment groupings (DRG, APC), modifier assignments, POA assignments, discharge disposition assignments, compliance, and data management.
  • Support chart sample selection for reviews and randomization in coordination with Coding Managers.
  • Contribute to finalizing an annual work plan for targeted chart reviews and pre-bill assessments.
  • Collaborate with the Coding Integrity Department to recommend and assist in creating resources that enhance coder knowledge and expertise. Analyze results and perform trend analyses to identify patterns in coding practices that require educational intervention.
  • Achieve or exceed an accuracy rate of 95%.
  • Ensure that coding reviews are effective and appropriate, assessing their impact through associate evaluations.
  • Exhibit strong written and verbal communication skills.
  • Work independently in a remote environment with minimal supervision.
  • Perform other duties as assigned by the Manager.

Qualifications:

  • High school diploma or equivalent experience required.
  • Completion of an accredited Baccalaureate program in Health Informatics or Health Information Management, or an AHIMA-approved Coding Certificate Program is preferred.
  • A minimum of five (5) years of inpatient and/or outpatient coding experience in an acute care setting is preferred.
  • Registered Health Information Administrator (RHIA) certification (AHIMA) is required.
  • Registered Health Information Technician (RHIT) certification (AHIMA) is required.
  • Certified Coding Specialist (CCS) certification (AHIMA) is required.

Work Type:

Full Time

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