- Job Title:
- Coding Quality Analyst - Lead
- Job ID:
- Shared Services
- Full/Part Time:
- FTE %:
- Salary Range Min:
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Coding Quality Analyst - Lead (Job Opening 443718) - Scope of Position
The Lead Coding Quality Analyst for Coding Audits will review randomly selected and focused medical records for accurate selection of appropriate admitting and discharge diagnoses, ICD-9-CM, ICD-10-CM/PCS and CPT-4 procedures. The Lead Coding Quality Analyst for coding audits is also responsible for ensuring the accuracy of coding and MS-DRG and APR-DRG assignment for medical records requested Recovery Audit Contractors, Medicaid Integrity Contracts and other third party payers for DRG validation. The Lead Coding Quality Analyst for coding audits is responsible for providing feedback to the Administrative Director of Medical Information Management and Director of Coding and Compliance regarding trends and coding quality issues and make recommendations to improve accuracy in coding.
The Lead Coding Quality Analyst for coding audits will coordinate monthly, quarterly and/or yearly coding audits to ensure complete and accurate coding, DRG/MS-DRG assignment for hospital reimbursement, research and planning. Random and focused coding audits are conducted to meet organization wide quality initiatives and in response to payer targeted DRGs. This position is responsible for initiating appeals, when appropriate, in response to all payer DRG reassignment requests and the appeal process is in accordance with CMS guidelines. The analyst keeps detailed records of all audits conducted, the results, recommendations, and follows-up to assure action is taken. The lead analyst is responsible for identifying coding quality improvement issues as related to results of RAC reviews and other reviews conducted by internal and outside auditors and advises medical record coding specialist on coding guidelines and practices as requested.
Education and experience
Candidate must have a HS diploma or GED. An Associate?s or Bachelor?s degree in health information management is preferred.
Certifications can include: Registered Health Information Administrator (RHIA), Registered Health Information Record Technician (RHIT) or a Certified Coding Specialist (CCS) by the American Health Information Management Association, or equivalent education and experience.
Minimum of two years coding experience, which includes validation of diagnosis, procedure codes, MS-DRG/APR-DRGs and resolving claim/coding edits is required. Previous project management/supervisory experience preferred.