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Guidehouse
remote, NA, United States
23 days ago
Guidehouse
Remote, United States
23 days ago

Description

Coding Quality Reviewer- Acute Care Hospital Inpatient

Why Work for Guidehouse?

  • Recognized leader in hospital revenue cycle management 
  • Well- established remote medical coding team
  • A focus on career development and learning opportunities
  • Offering flexible hours, competitive compensation, comprehensive benefits, and paid time off

Position Description:

The Coding Quality Reviewer- Hospital Inpatient shall report directly to the Internal Quality Control Coding Director and will be responsible for accessing and reviewing the medical record documentation, coding and abstracting accuracy as performed by the Guidehouse coding team by utilizing ICD-10 CM/PCS and CPT coding classification systems. Review of patient records will be conducted via facility EMR, scanning technology or other established method.

Responsibilities:

  • Ensure 3-5% coding quality review (or percentage stipulated in client contract) of each coder’s work is conducted monthly for those facilities the reviewer is assigned.
  • Coding quality review will be conducted to identify abstracting (to include dc disposition and POA indicators), ICD-10-CM, ICD-10-PCS, CPT, modifier, and HCPCS coding errors for codes assigned by the coding team (see quality review policies for review details).
  • Reviewer will run coder productivity reports (where applicable) to pull random sample accounts for review and to ensure review percentages are met per facility contract.
  • Review coding and abstracting on all patient types assigned
  • Review all Coding Clinics and CPT Assistant updates and stay abreast of all new coding guidelines.
  • Ensure code recommendations are supported with AHA Coding guidelines, Coding Clinics, CPT Assistant and/or other official coding references. Reviewers will also document the specific record documentation that supports any code recommendation.
  • Perform chart reviews and coding recommendation notifications to coding team in a timely manner (same day review conducted).
  • Enter review findings in a timely manner for each account reviewed into audit software daily or at a minimum within 24 hours of review.
  • Communicate in a professional, non-threatening mentorship manner with the coding team in coding quality recommendation discussions.
  • Assist Coders in answering coding/abstracting questions resulting from the quality reviews.
  • Reviews monthly and quarterly coder quality reports and performs intensification reviews for Coders who fall below the stipulated accuracy rate as part of the corrective action plan.
  • Maintains a working knowledge of ICD-10-CM/PCS and CPT coding principles, governmental regulations, official coding guidelines, and third party requirements regarding documentation and billing.
  • Complete review activity summary daily (productivity summary) for each facility and submit to IQC Manager and VP of Quality on a weekly basis (utilized to calculate quality review FTEs assigned to each facility).
  • Provide company support for the creation, maintenance and ongoing operation of an efficient and accurate Quality Improvement Plan that is compliant with Local, State, and Federal Government Regulations.
  • Work with the Coding Solutions Division to provide on-going coding education resulting from the Quality Reviews. This will involve direct one-on-one correspondence between the coder and reviewer.
  • Maintain open lines of communication serving as a liaison between client, Coders, and Coding Solutions Division to insure that all parties are kept up to date on specific hospital guidelines/policies.


Requirements

  • Must hold one of the following credentials: (RHIT, RHIA, CCS, CIC or COC).
  • Must have three years previous coding/ reviewer experience.
  • Personal responsibility, respect for self and others, innovation through teamwork, dedication to caring and excellence in customer service.

Job Information

  • Job ID: 58941591
  • Location:
    Remote, United States
  • Company Name: Guidehouse
  • Position Title: Coding Quality Reviewer- Hospital Inpatient
  • Industry: Hospital
  • Job Function: Coding - Inpatient
  • Job Type: Full-Time
Chicago , IL , US

About Guidehouse: Guidehouse is a leading global provider of consulting services to the public and commercial markets with broad capabilities in management, technology, and risk consulting. We help clients address their toughest challenges and navigate significant regulatory pressures with a focus on transformational change, business resiliency, and technology-driven innovation. Across a range of advisory, consulting, outsourcing, and digital services, we create scalable, innovative solutions that prepare our clients for ...

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