HIM Coding Quality Officer III, Remote

Job Title:

Quality Officer III

Location:

System Business Office

Department Name: HIM - Coding Quality

Req #:

Status:
Salaried

Shift: Day

Pay Range: $87,313.00 - $ per year

Pay Transparency:

The above reflects the anticipated annual salary range for this position if hired to work in New Jersey.

The compensation offered to the candidate selected for the position will depend on several factors, including the candidate's educational background, skills and professional experience.

The position is remote, but candidates must be based in New Jersey, New York or Pennsylvania.

Job Overview:

The Quality Officer III is responsible for ensuring accuracy and integrity of ICD-10-CM/PCS coding and DRG assignment for inpatient Medicare encounters. The Quality Officer III must also sustain an excellent organizational average accuracy rate. Adherence to applicable Federal and State Regulations, Compliance Guidelines, and Coding Guidelines set forth by RWJBH, American Hospital Association (AHA) and the American Medical Association (AMA) must be maintained.

Qualifications:

Required:

• Bachelor’s degree and 5+ years experience within acute care coding and/or auditing with a concentration on inpatient Medicare records or 9+ years of experience within acute care coding and/or auditing with a concentration on inpatient Medicare records in lieu of 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
• Knowledge of Medicare and Medicaid billing and coding regulations
• Excellent interpersonal, oral and written communication skills
• Excellent organizational and time management skills
• Must be able to work independently and cooperatively with minimal supervision

Preferred:

• CPC-H, RHIT, RHIA and/or RN licensure

Certifications and Licenses

Required:

• CCS certification

Scheduling Requirements:

• 8:00am - 4:30pm, Monday - Friday
• Full Time (40 hours per week)
• Remote - must reside in NJ, PA, or NY

Essential Functions:

• Ensures the accuracy and integrity of ICD-10-CM/PCS, CPT coding when applicable and DRG assignment for adherence to Federal and State Regulations and Compliance Guidelines
• Critically analyzes each Medicare 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
• Independently manages EPIC SMART WQ’s to assure proper workflow of identified accounts
• 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. Coding advice must be clearly and concisely written with appropriate clinical indicators cited. Additional facilities that may join the System receive the same education and coaching from the Quality Officers to ensure a unified methodology within the RWJBH organization.
  
  This results in improved outcomes in DRG assignment, coder education and DNB lag time within all facilities
• Sustains an excellent organizational average accuracy rate by leveraging advanced knowledge of coding practices leading to exceptional results
• The Quality Officer’s coding analysis is reviewed by the Coding Specialists on a biannual basis. The consequences of incorrect judgments affecting the DRG may include an increased monitoring, until quality scores of 90% or better for two consecutive months are obtained. The consequences of incorrect coding resulting in erroneous DRGs includes under reporting and/or over reporting. Incorrect coding may result in an incorrect reporting of diagnoses and procedures to the patient’s EHR which may affect the patient’s future care, insurance claims and coverage.
  
  When accounts are not reviewed and released in a timely manner, there is a detrimental impact to the reimbursement flow for the facility (DNB)
• Productivity Standards must be met for all Quality Officers. Failure to meet productivity standards will result in progressive disciplinary action
• Provides…