Coding Quality Specialist

Overview

• Operate in a remote environment supporting coding quality review systems and tools.
• Perform internal quality assessments to ensure compliance with coding guidelines and policies.
• Ensure accurate and consistent coding for appropriate reimbursement and data integrity.
• Collaborate with Health Information Management Service Centers (HSCs) for coding reviews.
• Maintain productivity and accuracy standards exceeding 95%.
• Participate in special reviews and projects to enhance coding practices.
• Stay updated on coding guidelines, policies, and clinical resources.
• Contribute to the improvement of coding quality and adherence to standards.

Key Responsibilities & Duties

• Lead and coordinate quality reviews for inpatient and outpatient coding.
• Ensure adherence to coding guidelines and organizational policies.
• Apply expert knowledge of medical coding practices and concepts.
• Participate in special projects and reviews to enhance coding accuracy.
• Maintain productivity and accuracy standards as per organizational requirements.
• Conduct educational sessions to ensure coding knowledge remains current.
• Review official data quality standards and clinical resources regularly.
• Support coding staff in achieving compliance and quality benchmarks.

Job Requirements

• Bachelor of Science (BS) in Health Information Management or related field preferred.
• RHIA, RHIT certification and/or mandatory IP Coding Auditor for MS-DRG.
• Minimum of 3 years hands-on coding experience in MS-DRG auditing.
• Expertise in all body systems coding; specialization not preferred.
• Proficiency in coding guidelines, policies, and clinical resources.
• Ability to meet productivity and accuracy standards exceeding 95%.
• Experience in hospital coding and auditing environments.
• Completion of coding test as part of the selection process.