This is a remote position.
The Coding Quality Auditor and Specialist is responsible for assuring coding guidelines and regulations are not compromised during the decision-making process related to clinical documentation and the coding of this documentation. This position partners with Clinical Documentation Nurses, Physicians, and other licensed providers to improve the quality of documentation, assuring best quality performance and representation of care provided. In addition, the Coding Quality Auditor and Specialist collaborates with the CMOs to ensure the integrity of the Health Record is established through best practices in Clinical Documentation and Coding.
The Coding Quality Auditor and Specialist is responsible for maintaining quality work queues and quality reports, advanced and complex project work that includes but, is not limited to, Risk Adjustment, Mortality Review, Hospital Acquired Condition (HAC) and Patient Safety Indicator (PSI) Review, Quality Abstraction and Analysis, and/or special and non-traditional project work. Incumbents to this role have a mastery of advanced clinical documentation integrity and quality concepts, coupled with the ability to consistently identify root causes and deliver measurable results. Key to this role is the ability to lead and facilitate quality initiatives and external rankings initiatives.
The Coding Quality Auditor and Specialist solves complex problems and adds new perspectives to existing solutions. The Coding Quality Auditor and Specialist applies advanced knowledge of the national quality agenda and clinical documentation integrity and coding compliance to advance problem analysis and creative process.
RESPONSIBILITIES
§ Collaborates with clinical documentation team in the review of inpatient accounts (with an emphasis on mortality reviews) identifying documentation improvement opportunities
§ Assess DRG, PDx, secondary Dx, PCS, POA and all other components of documentation that impact quality metrics
§ Consistently assures coding practices remain compliant with coding guidelines and regulations
§ Continually identifies educational opportunities related to coding and documentation
§ Expert educator to clinical teams, medical staff and inpatient coders
§ Identifies strategic plans that will result in a positive impact to the clinical dashboard
§ Develops clinical relationships across the health system securing interdepartmental support necessary for successful implementation of education strategies assuring achievement of overall strategic targets
§ Ability to multi-task a variety of audits
§ Ability to analyze data and construct appropriate action plans
§ Develops teaching tools to promote quality outcomes
§ Is an active member of clinical and executive meetings as identified
§ Advanced understanding of quality metrics for health system (Vizient, PSI, USNWR, LeapFrog, AHRQ, CMS)
§ Advanced understanding of clinical documentation and coding through the lens of local and national quality and ranking methodologies, including but not limited to, U.S News and World Report, Vizient, Leapfrog, the CMS Star Rating, AHRQ and payer contracts and assists the Managers of Clinical Documentation and Coding in implementing key strategies to effect change.
§ Partners with Coding, Clinical Documentation leadership and Medical Directors to coordinate, maintain, and execute advanced project work that includes but, is not limited to, Mortality Review, HAC/PSI Review, Quality Abstraction and Analysis, and/or special and non-traditional project work.
§ Partners with several departments that includes but is not limited to: IT; Analytics; and Innovation to design and implement new and advanced workflow solutions.
§ Partners with third-party consultants/partners to contribute to workflow and methodology build and refine as necessary.
Requirements
Required:
- RHIT or RHIA or CCS Certification
- Certified Clinical Documentation Specialist(will consider CDIP certification)
- Bachelor Degree – Healthcare related(will consider candidate currently enrolled in Bachelor program)
- Five years of coding experience in area of expertise
- Clinical expertise and understanding achieved through prior experience working with clinical documentation teams
- Strong personal computer skills (Word, Excel, PowerPoint, Visio)
- Excellent verbal, written, and presentation skills
- Demonstrates critical thinking skills
- Excellent interpersonal skills
- Planning and time management skills
- Educational/training experience
Preferred:
· Master’s Degree in related field or currently enrolled in Master’s program
Management Responsibility:
- This position will not have direct reports.
Benefits
Skills Required
- RHIT or RHIA or CCS Certification
- Certified Clinical Documentation Specialist or CDIP
- Bachelor's degree in a healthcare-related field (or currently enrolled)
- Five years of coding experience in area of expertise
- Prior experience working with clinical documentation teams (clinical expertise)
- Strong personal computer skills (Word, Excel, PowerPoint, Visio)
- Excellent verbal, written, and presentation skills
- Demonstrates critical thinking skills
- Excellent interpersonal skills
- Planning and time management skills
- Educational/training experience
- Master's degree in related field or currently enrolled in Master's program
What We Do
Valerion Health provides healthcare outsourcing and revenue cycle management services for hospitals, physician groups, clinics, and other healthcare organizations. Its offerings include medical coding and auditing, billing, electronic data management, compliance support, education, and revenue-cycle analytics. The company combines onshore specialists with offshore teams to improve accuracy, reduce administrative burden and costs, prevent denials, and strengthen healthcare providers’ financial operations.
