Coding Quality Analyst I

1 week ago

Irving, Texas, United States Christus Health Full time

Overview:

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

The Coding Quality Specialist plays a vital role in the Health Information Management (HIM) department, reporting to the HIM Coding Education Manager. This position is responsible for conducting internal coding evaluations to support the operational needs of the Coding Operations Department. The role is essential in enhancing coding education and training, as well as facilitating pre-bill and cross-training to ensure the skillset of our health billing coding associates remains current and proficient.

This specialist demonstrates advanced knowledge and understanding of the latest ICD-10-CM, ICD-10-PCS, and/or CPT/HCPCS coding standards and practices across both inpatient and outpatient settings, maintaining a target accuracy rate of 95%.

Responsibilities include but are not limited to conducting PEPPER reviews, onboarding and standard pre-bill assessments, remediation and performance improvement evaluations, and reviews required for corrective action plans, query quality, and other focused assessments as necessary. The Coding Quality Specialist will ensure quality in areas such as POA assignment, principal and secondary diagnosis coding, procedural coding, modifier application, discharge disposition verification, query opportunities, and accuracy in DRG and APC assignments.

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

The Coding Quality 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 comprehensive inpatient and outpatient coding evaluations.
  • Effectively communicate findings in both verbal and written formats to support training and educational initiatives.
  • Assist in the development and coordination of review plans, providing feedback to coding staff and management regarding query opportunities, documentation enhancements, accurate code assignments (ICD, CPT, HCPCS), and compliance with data management standards.
  • Support chart sample selection for reviews and ensure randomization in coordination with Coding Managers.
  • Contribute to the formulation of an annual work plan targeting chart reviews and pre-bill assessments.
  • Collaborate with the Coding Integrity Department to recommend and assist in the creation of resources that enhance coder knowledge and expertise, while reviewing results and performing trend analyses to identify areas needing educational focus.
  • Achieve or exceed a coding accuracy rate of 95%.
  • Ensure the effectiveness of coding reviews and assess 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 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 health billing coding experience in an acute care environment 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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