Quality Analyst
QualityAnalyst-MultispecialtyE/MProfeeCoding
Neural analysis suggests this role is
optimal for Senior candidates.
“Quality Analyst - Multispecialty E/M Profee Coding at Quality Analyst. Skills: Medical Coding, Quality Assurance, Process Management, Cross-functional Coordination, Vendor/Stakeholder Management, Operational Metrics, Resource Planning, Continuous Improvement. Plans, monitors, directs and evaluates 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.; Meets agreed sampling targets and accuracy.; Ensures accurate, sensible & on-time client schedules.; Identifies risk areas.; Development of training and education programs.; Development/implementation of standardization within the organization.
Industry & Context.
Implements measures/schedules to return to established schedules at the earliest possible time in case of system issues or other emergencies.; Reviews medical record documentation for accuracy in code assignment when documentation is inadequate, ambiguous, or unclear for coding purposes.
Travel Required: None, Clearance Required: None, Rotational arrangement and flexibility to work with any given team as assigned.
What They're Looking For.
Must Have
Medical Coding, 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.
directs and evaluates 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.
Implements measures/schedules to return to established schedules at the earliest possible time in case of system issues or other emergencies.
Ensures that the QA communicates a valid
workable schedule for his or her client each week.
Reviews medical record documentation for accuracy in code assignment of the primary/secondary diagnosis and procedures using ICD-9-CM and CPT-4 coding conventions.
Sequences the diagnosis and procedures using coding guidelines.
Ensures MS-DRG/APC assignment is accurate.
Abstracts and compiles 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).
Provides 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.
Maintains 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.
Assists with research and development and presentation of continuing education programs on areas of specialization.
Assists with special projects as required.
Understands and abides by the organizations’ information security policy and protects the confidentiality
integrity and availability of all information assets.
Reports incidents related to security of information to concerned authorities.
How You'll Work.
Team & Collaboration
Communicates with Director, and Coding Operations.; Works closely with each quality specialist.; Answers queries from the quality staff.; 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.
Communication Scope
Communicates with Director, and Coding Operations.; Answers queries from the quality staff.; Presents continuing education programs.
Process & Methodology
Schedule management, Resource planning, Project launch involvement
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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