RWJBarnabas Health is hiring: Quality Officer III (Inpatient Coding Review) - Hy

Quality Officer III (Inpatient Coding Review) - Hybrid/Remote

Req #: 0000175903

Category: Coder

Status: Full-Time

Shift: Day

Facility: RWJBarnabas Health Corporate Services

Department: HIM - Coding Quality

Location:

System Business Office,
2 Crescent Place, Oceanport, NJ 07757

Job Overview:

The Quality Officer 3 is responsible for ensuring accuracy and integrity of ICD-10-CM/PCS coding and DRG assignment for inpatient Medicare encounters. This requires critical thinking and a higher level skill set due to the complexity and risk relative to Medicare patients. Quality Officer 3 must also sustain an excellent organizational average accuracy rate. Adherence to applicable Federal and State Regulations, Compliance Guidelines, and Coding Guidelines set forth by RWJBH, American Hospital Association (AHA) and the American Medical Association (AMA) must be maintained.

Qualifications:

Required:

• Bachelor's degree or equivalent in experience.
  • 5+ years acute care coding and/or auditing experience with a concentration on inpatient Medicare records is required with a Bachelor's degree.
  • 9+ years acute coding and/or auditing experience required without a Bachelor's degree.
• Extensive knowledge of ICD-10-CM/PCS and CPT coding, medical terminology, human anatomy and physiology, clinical indicators associated with disease processes and pharmacology is required.
• Knowledge of Medicare and Medicaid billing and coding regulations.
• Must have excellent interpersonal, oral, and written communication skills. Must be capable of critical thinking and analysis and written conveyance of same.
• Must have excellent organizational and time management skills.
• Must maintain a professional demeanor.
• Must be able to work independently and cooperatively with minimal supervision.
• Must foster positive relationships with fellow co-workers and the coding team.

Certifications and Licenses Required:

• CCS required
• ICD-I0-CM/PCS proficiency required.

Preferred:

• CPC-H, RHIT, RHIA and/or RN also encouraged.

Scheduling Requirements:

• Position is primarily remote with occasional onsite requirement.

Essential Functions:

• Ensures the accuracy and integrity of ICD-10-CM/PCS, CPT coding when applicable and DRG assignment for adherence to Federal and State Regulations and Compliance Guidelines.
• Critically analyzes each Medicare inpatient medical record to apply appropriate coding, DRG judgements, SOI, ROM and POA.
• Independently manages SMART pending queues for all acute care RWJBarnabas facilities. Reviews ICD-10-CM/PCS coding and DRG assignment of medical records as flagged by SMART.
• Independently manages EPIC SMART WQ's to assure proper workflow of identified accounts.
• Directs coders with appropriate case-specific recommendations. Educates and coaches coders in the application of coding principles, code assignment and sequencing, DRG assignment and clinical disease processes.
• Sustains an excellent organizational average accuracy rate by leveraging advanced knowledge of coding practices leading to exceptional results.
• The Quality Officer's coding analysis is reviewed by the Coding Specialists on a biannual basis.
• Productivity Standards must be met for all Quality Officers. Failure to meet productivity standards will result in progressive disciplinary action.
• Provides Guidance to Quality Officer 1 and 2 as requested.
• Independently monitors SMART queues to ensure all records imported by SMART are reviewed and properly directed.
• Works as a team with other Quality Officers to ensure SMART review goals are met for all RWJBarnabas facilities.
• May review ICD-10-CM/PCS coding associated with RAC audits and/or other additional medical records as needed.
• Maintains proper computer and written records of all review activity.
• Effectively communicates coding recommendations and rationale to Coding team.
• Performs regulatory coding research as needed.
• May be required to perform other related duties.

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Additional Information:

At RWJBarnabas Health, our market-competitive Total Rewards package provides comprehensive benefits and resources to support our employees physical, emotional, social, and financial health.

• Paid Time Off (PTO)
• Medical and Prescription Drug Insurance
• Dental and Vision Insurance
• Retirement Plans
• Short & Long Term Disability
• Life & Accidental Death Insurance
• Tuition Reimbursement
• Health Care/Dependent Care Flexible Spending Accounts
• Wellness Programs
• Voluntary Benefits (e.g., Pet Insurance)
• Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon, and more!

Choosing RWJBarnabas Health!

RWJBarnabas Health is the premier health care destination providing patient-centered, high-quality academic medicine in a compassionate and equitable manner.

RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state.

Equal Opportunity Employer