Guidehouse
QualityAnalyst-HCC/E/m(CRCCerified)ProfeeCoding
Neural analysis suggests this role is
optimal for Senior candidates.
“Quality Analyst - HCC/E/m (CRC Cerified) Profee Coding at Guidehouse. Skills: Medical Coding, QA production monitoring, client communication, medical record review, coding accuracy, QA data documentation, coding compliance management. Plans, monitors, direct and evaluate QA production on a daily basis.. Ensures that daily schedules are met and communicates with Director, and Coding Operations if situations occur that hinder meeting deadlines.”
What You'll Achieve.
Ensures that daily schedules are met; return to established schedules at the earliest possible time.; communicates a valid, workable schedule for his or her client each week.; Accurate, sensible & on-time.; Meets agreed sampling targets and accuracy.; reporting to the client; identifying risk areas; development of training and education programs; development/implementation of standardization within the organization.
Industry & Context.
implement measures/schedules to return to established schedules at the earliest possible time.; reviewing code assignments that are not straightforward or the documentation in the record is inadequate, ambiguous, or unclear for coding purposes.; identifying risk areas
Travel Required: None, Clearance Required: None, Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines., Shall understand and abide by the organizations’ information security policy and protect the confidentiality, integrity and availability of all information assets., Shall report incidents related to security of information to concerned authorities.
What They're Looking For.
Must Have
Accredited medical coders (CCA, CCS, CPC, CPC-H) with at least 3+ years’ experience.
Nice to Have
Experience is Microsoft Excel, Word and PowerPoint.
What You'll Do.
direct and evaluate QA production on a daily basis.
Ensures that daily schedules are met and communicates with Director
and Coding Operations if situations occur that hinder meeting deadlines.
Implement measures/schedules to return to established schedules at the earliest possible time.
Ensures that the QA communicates a valid
workable schedule for his or her client each week.
Review medical record documentation for accuracy in code assignment of the primary/secondary diagnosis and procedures using ICD-9-CM and CPT-4 coding conventions.
Sequence the diagnosis and procedures using coding guidelines.
Ensure MS-DRG/APC assignment is accurate.
Abstract and compile data from medical records for appropriate optimal/complaint reimbursement for hospital and/or professional charges.
Answers queries from the quality staff on a day to day basis and escalating to the Director of Coding as necessary.
Meets agreed sampling targets and accuracy.
Keeps abreast of coding guidelines and reimbursement reporting requirements.
Documents QA data on teams of QA/coders and records findings in the QA system (Guide Audit).
Guidance and mentorship of coders.
Helps to ensure that continuing education is planned
scheduled and completed for all coding/QA teams.
Coordinates scheduled quality meetings with the QA and production staff.
Brings identified concerns to Guidehouse’s coding compliance management for discussion.
Active involvement in project launch sessions along with team leaders to understand the coding process.
Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines.
Maintain a thorough understanding of anatomy and physiology
disease processes and surgical techniques to effectively apply ICD-9-CM and CPT-4 coding guidelines to inpatient and outpatient diagnoses and procedures.
Assist with research and development and presentation of continuing education programs on areas of specialization.
Assist with special projects as required.
Understand and abide by the organizations’ information security policy and protect the confidentiality
integrity and availability of all information assets.
Report incidents related to security of information to concerned authorities.
How You'll Work.
Team & Collaboration
communicates with Director, and Coding Operations; closely with each quality specialist; coordinates scheduled quality meetings with the QA and production staff; Brings identified concerns to Guidehouse’s coding compliance management for discussion; Active involvement in project launch sessions along with team leaders; flexible to work with any given team as assigned
Communication Scope
communicates with Director, and Coding Operations; Answers queries from the quality staff; reporting to the client; development of training and education programs; presentation of continuing education programs
Process & Methodology
Plans, monitors, direct and evaluate QA production on a daily basis., Ensures that daily schedules are met, implement measures/schedules to return to established schedules at the earliest possible time., Responsible for ensuring that the QA communicates a valid, workable schedule for his or her client each week., Accurate, sensible & on-time., Project Launch, Focused client launches
Full Job Description
**_Job Family_ :** Coding Quality OP (India) **_Travel Required_ :** None ** _Clearance Required_ :** None ** _What You Will Do_ :** * Plans, monitors, direct and evaluate QA production on a daily basis. Ensures that daily schedules are met and communicates with Director, and Coding Operations if situations occur that hinder meeting deadlines. If system issues or other emergencies delay QA, an implement measures/schedules to return to established schedules at the earliest possible time. This should be done closely with each quality specialist to ensure the needs are met and that satisfy our client requirements. * Responsible for ensuring that the QA communicates a valid, workable schedule for his or her client each week. Accurate, sensible & on-time.**If this doesn’t happen properly, it’s the responsibility of the Lead QA Specialist to make it happen promptly. * Review medical record documentation for accuracy in code assignment of the primary/secondary diagnosis and procedures using ICD-9-CM and CPT-4 coding conventions. Sequence the diagnosis and procedures using coding guidelines. When applicable, ensure MS-DRG/APC assignment is accurate. Abstract and compile data from medical records for appropriate optimal/complaint reimbursement for hospital and/or professional charges. This involves reviewing code assignments that are not straightforward or the documentation in the record is inadequate, ambiguous, or unclear for coding purposes. * Answers queries from the quality staff on a day to day basis and escalating to the Director of Coding as necessary. * Meets agreed sampling targets and accuracy. * Keeps abreast of coding guidelines and reimbursement reporting requirements. * Documents QA data on teams of QA/coders and records findings in the QA system (Guide Audit), which will be for reporting to the client, identifying risk areas, development of training and education programs and development/implementation of standardization within the organization. This also inv
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