Parallon believes that organizations that continuously learn and improve will thrive. That's why, after more than a decade, Parallon remains dedicated to helping hospitals and hospital systems operate knowledgeably, intelligently, effectively and efficiently in the rapidly evolving healthcare marketplace, today and in the future.
As one of the healthcare industry's leading providers of business and operational services, Parallon is uniquely equipped to provide a broad spectrum of customized services in the areas of revenue cycle, purchasing, supply chain, technology, workforce management and consulting.
Parallon's purpose is simple. We serve and enable those who care for and improve human life in their communities.
The Coding Quality Reviewer(CQR) performs internal quality assessment reviews on Health Information Management Service Center(HSC) coders to ensure compliance with national coding guidelines, the HSC coding policies and the Company coding policies for complete, accurate and consistent coding which result in appropriate reimbursement and data integrity. CQR review outcomes are communicated to the HSC team to improve the accuracy, integrity and quality of patient data, to ensure minimal variation in coding practices and to improve the quality of physician documentation within the body of the medical record to support code assignments. Outcomes are communicated to the HSC to provide specific coder education and global coding education based on the quality monitoring review findings and trends.
SUPERVISOR - Coding Quality Manager
SUPERVISES - None
DUTIES INCLUDE BUT ARE NOT LIMITED TO:
- Leads, coordinates and performs all functions of quality reviews (routine, pre-bill, policy driven and incentive plan driven)for inpatient and outpatient coding across multiple HSCs
- Assists in ensuring HSC coding staff adherence with coding guidelines and policy
- Demonstrates and applies expert level knowledge of medical coding practices and concepts
- Participates on special reviews or projects
- Maintains or exceeds 95% productivity standards
- Maintains or exceeds 95¬curacy
- Meets all educational requirements as stated in current Company policy
- Reviews all official data quality standards, coding guidelines, Company policies and procedures, and clinical/medical resources to assure coding knowledge and skills remain current
- Practices and adheres to the "Code of Conduct" philosophy and "Mission and Value Statement"
- Other duties as assigned
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
KNOWLEDGE, SKILLS, & ABILITIES
- This position requires the following minimum requirements:
- Coding Technical/Professional Knowledge and Skills- extensive regulatory coding, (ICD-10-CM, ICD-10- PCS, CPT-4, Modifiers, MS-DRGs, POA assignment and where applicable APR-DRGs and APCs) and associated reimbursement knowledge
- Effective Decision Making - relating and comparing; securing relevant information and identifying key issues; committing to an action after developing alternative courses of action that take into consideration resources, constraints, and organizational values
- Adaptability to major changes in work responsibilities or environment; adjusting effectively to work within newwork structures, processes, requirements, or cultures
- Initiative - independently takes prompt proactive steps toward problem resolution
- Contributing to Team Success by actively participating as a member of the team to move the team toward the completion of goals
- Work Standards -setting high standards of performance for self and others; assuming responsibility and accountability for successfully completing assignments or tasks; self-imposing standards of excellence rather than having standards imposed
- Organization - establishing courses of action to ensure that work is completed efficiently; proactively prioritizes assignments and keen ability to multi-task
- Communication - communicates clearly, proactively and concisely with all key stakeholders
- Leadership -leads individuals and groups toward desired outcomes, setting high performance standards and delivering leading quality services
- Customer Orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations
- Policies & Procedures- articulates knowledge and understanding of organizational policies, procedures and systems
- PC Skills- demonstrates proficiency in Microsoft Office applications and others as required
- Quality Orientation - accomplishing tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time
- Work Independently in a Remote Environment - is self-supporting; not needing to rely on others to complete a job
- Building and Maintaining Strategic Working Relationships -develops collaborative relationships to facilitate the accomplishment of work goals. Possesses good interpersonal skills in building, negotiating, and maintaining crucialrelationships
- Managing Conflict - dealing effectively with others in an antagonistic situation; using appropriate interpersonal styles and methods to reduce tension or conflict between two or more people
- Mentor and Educate - provides timely guidance and feedback to help strengthen the knowledge/skill set of others to accomplish a task or solve a problem
- Undergraduate degree in HIM/HIT preferred
- Equivalent work experience may substitute degree requirement
- Minimum of 3 years' acute care inpatient/outpatient coding experience preferred
- Minimum of 3 years' coding auditing/monitoring experience strongly preferred
- RHIA,RHIT and/or CCS preferred