Job Category

Revenue Cycle

Work Shift/Schedule

8 Hr Morning - Afternoon

Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

About the Role

Job Summary

The Coding Quality Reviewer II is responsible for performing quality analysis of coded medical records, documenting the analysis, summarizing the metrics and reporting quality statistics to management. Responsible for complex multi-specialty coding to include but not limited to: Neurosurgery, UI, Neurology, Critical Care, hospitalists, surgical and others as defined. The Coding Quality Reviewer II is also responsible for communicating identified issues to coding staff and management, as well as reviewing and correcting coding issues from the EMR and PMS systems. In addition, the Coding Quality Reviewer II may be called upon to provide education to staff and clients, prepare coding audits for physician education, and/or coding charts as business needs dictate.

The Coding Quality Reviewer II is responsible for providing and ensuring accurate, complete and timely coding of professional services to include all surgical and inpatient services. All coding staff must ensure accuracy and compliance with regulatory standards. Coding Quality Reviewer II is also responsible for performing audits in accordance with NGPG’s annual Compliance Work Plan and preparing written and oral communications to the Coding Compliance Manager.

Minimum Job Qualifications

Licensure or other certifications: CPC and/or CCS-P Coding Certification required
Educational Requirements: High School Diploma or GED
Minimum Experience: Three (3) years experience coding Multi-Specialty records required.
Other:

Preferred Job Qualifications

Preferred Licensure or other certifications:
Preferred Educational Requirements:
Preferred Experience:
Other:

Job Specific and Unique Knowledge, Skills and Abilities

Extensive knowledge of ICD-9, CPT, HCPCS coding, medical terminology, federal and state regulatory guidelines and third party payor requirements required
Accuracy and attention to detail imperative
Ability to interact well with others at all levels with a flexible, energetic, proactive and positive style
In-depth knowledge of Optimal coding policy and procedures
Highly skilled proficient with Microsoft Office products
Ability to communicate (both verbally and written) technical coding information to both technical and non-technical audiences
Ability to organize data and provide detailed reporting
Ability to prepare presentations and present to large or small audiences
Must be highly motivated, detail oriented individual
Excellent written and oral communication skills
Problem solving and analytical skills
Ability to be a self starter/work independently and as a team player
Ability to travel to NGHS/NGPG sites as needed

Essential Tasks and Responsibilities

Perform timely, concurrent quality review of coded medical records.
Correct errors identified in the quality process in both EMR and PMS systems.
Maintain coding quality statistics and provide detailed reporting to management.
Communicate errors to the Posting, Clinicians and AR staff on an individual basis.
Communicate to management any problem areas identified in the quality process and steps taken to resolve.
Assist with the review and correction of coding errors in the billing process (TM queues).
Assist with the review and correction of coding errors in the electronic claims process (clearinghouse on-line errors).
Promptly and professionally respond to both verbal and written coding questions from the internal staff and other areas of the company.
Review documentation deficiencies for accuracy and communicate identified errors to the coding staff and management.
Prepare documentation audits as needed for on-site physician education.
Production coding of medical records as per business needs.
Adherence to Coding policy and procedures.
Review charge slips/cards for completeness (providers are ultimately responsible for codes they assign).
Attends Regional and Local sponsored in-services and/or continuing education.
Participates in professional development activities and maintains professional affiliations as necessary.
Provide and/or validate CPT, ICD-9-CM and HCPCS coding of professional services for outpatient clinics, outreach offices or programs, minor diagnostic procedures, and/or ancillary services.
Review charge tickets for missing or inaccurate information. Items reviewed include service and diagnosis codes units of service, modifiers, facility code, place of service, provider billing numbers, etc.
Communicate with providers and clinic staff to ensure charge capture of all professional services, supplies, drugs, vaccinations, etc.
Monitor reconciliation procedures to ensure all charges are captured and billed in a timely manner.
Research and correct claims manager edits in a timely manner by applying coding and carrier specific guidelines while maintaining compliance initiatives.
Provide coding coverage to other specialties, departments, divisions, and/or units as required.
Attend billing educational sessions to enhance coding knowledge i.e. American Academy of Professional Coders, Professional Medical Coding Curriculum, NGPG Compliance Proficiency training, specialty seminars.
Performs other job duties as assigned.
Cross trains in other positions as requested.

Physical Demands

Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time
Weight Carried: Up to 20 lbs, Occasionally 0-30% of time
Vision: Moderate, Frequently 31-65% of time
Kneeling/Stooping/Bending: Occasionally 0-30%
Standing/Walking: Occasionally 0-30%
Pushing/Pulling: Occasionally 0-30%
Intensity of Work: Frequently 31-65%
Job Requires: Reading, Writing, Reasoning, Talking, Fingering, Driving

Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals.

NGHS: Opportunities start here.

Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.

Coding Quality Reviewer II - PSA - CPC CCS - 100% Remote - Excludes some states

Job Type