HIM Cert Coder/Quality Review Analyst

Position Summary:


This position is responsible for timely and accurate quality review of both internal and vendor coding team members to assure compliance with coding guidelines and standards in addition to their foundation coding responsibilities. The position performs quality checks on coding and provides feedback to coders to assure the timely and accurate coding of medical charts for billing. This will be heavier during onboarding and fulfillment of quality goals for new coding team members. In collaboration with HIM coding management, the coder/quality review analyst will assist with selection of coders and encounters to be reviewed, as well as education to be presented to the coder based on review outcomes. The coder/quality review analyst will also bring forward any issues related to documentation or systems as they are discovered during the review process. Much of the time the coder will work as a production coder to prevent backlogs and assure timeliness of coding. When all codes have successfully met their onboarding goals, periodic quality checks will be conducted by this role.

Qualifications:


CERTIFICATION & LICENSURE REQUIREMENTS
Certified Professional Coder (AAPC) upon hire or Certified Inpatient Coder (AAPC) upon hire or Certified Professional Coder - Hospital upon hire or Registered Health Information Admin (AHIMA) upon hire or Registered Health Information Tech (AHIMA) upon hire or Certified Coding Specialist Physician Based upon hire or Certified Coding Specialist (AHIMA) upon hire.

EXPERIENCE REQUIREMENTS
Minimum two years coding experience

SKILLS AND KNOWLEDGE
In depth knowledge of ICD10CM, ICD10PCS, HCPCS, CPT E/M or CPT Surgical coding. Ability to communicate well with coders, vendors and HIM leaders. Ability to present ideas and concepts through media such as power point and LMS. Working knowledge of Microsoft products, such as Word and Excel. Ability to accurately track reviews and determine simple statistics.

Essential Functions:

• Perform accurate and timely quality reviews of internal and vendor coding team members using appropriate code sets and coding guidelines.
• Develop and perform timely coding education to internal and vendor coding team members on coding systems, coding standards, protocols and Carle coding workflow as required based on quality review outcomes.
• Perform as a production coder when needed in a manner aligned with current coding productivity and quality standards
• Shares results of quality reviews to HIM Leadership with recommendations for education and training
• Works with HIM leadership to determine frequency and scope of coding quality reviews for specific coders and vendors
• Compile and track statistics related to the review function, completed quality reviews, and follow up from those reviews
• Identifies coder training needs, system issues, and/or documentation issues and reports them timely to HIM leadership
• Review and respond to coding denials and coding questions as requested or assigned
• Participates in system and new application testing as needed

• Identifies work types to be reviewed based on the coding scope and new coder onboarding needs of the HIM department
• Develops and performs HIM coding team member group education on coding topics identified during quality reviews
• Assist the HIM coding management in assuring all coding performed by HIM or HIM vendors meets department standards