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Clinical Coding Quality Evaluator I

2 months ago

Irving, Texas, United States Christus Health Full time

Overview:

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

The Coding Quality Assurance Specialist works under the HIM Coding Education Manager to conduct internal coding assessments that align with 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 to ensure our healthcare coding associates maintain and improve their skill sets.

The Coding Quality Assurance Specialist exhibits extensive knowledge and understanding of current coding standards, including ICD-10-CM, ICD-10-PCS, and/or CPT/HCPCS, applicable in both inpatient and outpatient environments, achieving a minimum accuracy rate of 95%.

Responsibilities are determined by departmental requirements and may include PEPPER reviews, new hire assessments, standard pre-bill evaluations, remediation, performance improvement reviews, query quality assessments, and other focused reviews as necessary. The Coding Quality Assurance Specialist will evaluate quality concerning POA assignment, principal and secondary diagnosis coding, procedural coding, modifier application, discharge disposition verification, query opportunities, and DRG and APC accuracy.

This role will collaborate with various departments within CHRISTUS Health, including but not limited to 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 in production coding as required 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 System HIM Director.

Key Responsibilities:

  • Meet the expectations of the OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
  • Conduct inpatient and outpatient coding assessments.
  • Communicate findings clearly both verbally and in writing in an approved format to support training and education initiatives.
  • Assist in the development and coordination of review plans, providing feedback to coding staff and management regarding query opportunities, documentation improvements, accurate code assignment (ICD, CPT, HCPCS), payment groupings (DRG, APC), modifier assignment, POA assignment, discharge disposition assignment, compliance, and data management.
  • Support chart sample selection for reviews and coordinate randomization with Coding Managers.
  • Contribute to finalizing an annual work plan for targeted chart assessments and pre-bill reviews.
  • Collaborate with the Coding Integrity Department to recommend and assist in creating content and examples for Job Aides, Coding Best Practice references, and other resources to enhance coder knowledge and expertise. Analyze results and perform trend analyses to identify patterns in coding practices that require educational interventions.
  • Achieve or exceed an accuracy rate of 95%.
  • Ensure coding assessments are appropriate and effective, evaluating their impact through associate evaluations.
  • Demonstrate 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.
  • Five (5) or more years of inpatient and/or outpatient HB coding experience in an acute care setting is preferred.
  • Registered Health Information Administrator (RHIA) (AHIMA) certification is required.
  • Registered Health Information Technician (RHIT) (AHIMA) certification is required.
  • Certified Coding Specialist (CCS) (AHIMA) certification is required.

Work Type:

Full Time

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