Coding Quality Reviewer/Audit

Job Details

Coding Quality Reviewer/Audit

Job Description

Under the direction of Coding Management, Coding Quality Reviewer/Audit is responsible for the review of medical records to assure the accuracy of codes assigned for outpatient/inpatient medical records according to CPT-4 and/or ICD-10-CM/PCS coding rules and principles and supports a complete and accurate clinical and financial database. Perform quality assurance audits where directed. Compiles results and summary findings of reviews for management review and trending analysis. Prepares presentations and attends Committee meetings to review results. Interacts with Providers and Hospital Departments related to coding guideline education. Delivers feedback to the coding team for educational purposes.

1. Interacts with coworkers, visitors, and other staff consistent with the values of Jefferson.

2. Reviews coded records, analyzes, interprets and classifies clinical information in the medical record according to ICD-10-CM/PCS and/or CPT coding rules and principles. Abides by the Standards of Ethical Coding as set forth by the American Health Information.

3. Conducts review of coded records according to quality measures, risk variables and other specific documentation criteria, provides statistical analysis of error rates prior to bill processing. Share finding with coding staff for education. Forwards trends to claims data and regulatory quality measures.

4. Attend hospital quality and service line committee meetings to represent the Coding Department as it relates to agenda items for coding review results and coding guidelines education.

5. Prepare compliant queries to physicians and other clinical providers when documentation in the medical record is inadequate, ambiguous, or unclear for coding purposes.

6. Participate in all Coding Department in-service meetings or training sessions to maintain and enhance coding and auditing skills to stay abreast of changes in coding guidelines/regulations.

Required Knowledge, Skills, and Abilities:

Extensive knowledge of medical terminology, human anatomy and physiology, and clinical disease process required.

At least 10 years coding experience.

Knowledge of official coding guidelines and common billing regulations

Education:

Associate Degree or BS in Health Information Management, Nursing or related field.

Preferred Experience:

Knowledge of performance benchmark databases and risk variables such as Vizient, Publically reported clinical and claims data and regulatory quality measures.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Thomas Jefferson University Hospitals, Inc.

Primary Location Address

1401 Old York Road, Abington, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educa­tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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