Quality Assurance Specialist

QA Multispecialty E/m Profee

Job Family:

Travel Required:

Clearance Required:

What you will do:

• Plans, monitors, direct and evaluate QA production on a daily basis. Ensures that daily schedules are met and communicates with Director, and Coding Operations if situations occur that hinder meeting deadlines. If system issues or other emergencies delay QA, an implement measures/schedules to return to established schedules at the earliest possible time. This should be done closely with each quality specialist to ensure the needs are met and that satisfy our client requirements.

• Responsible for ensuring that the QA communicates a valid, workable schedule for his or her client each week. Accurate, sensible & on-time.**If this doesn't happen properly, it's the responsibility of the Lead QA Specialist to make it happen promptly.

• Review medical record documentation for accuracy in code assignment of the primary/secondary diagnosis and procedures using ICD-9-CM and CPT-4 coding conventions. Sequence the diagnosis and procedures using coding guidelines. When applicable, ensure MS-DRG/APC assignment is accurate. Abstract and compile data from medical records for appropriate optimal/complaint reimbursement for hospital and/or professional charges. This involves reviewing code assignments that are not straightforward or the documentation in the record is inadequate, ambiguous, or unclear for coding purposes.

• Answers queries from the quality staff on a day-to-day basis and escalating to the Director of Coding as necessary.

• Meets agreed sampling targets and accuracy.

• Keeps abreast of coding guidelines and reimbursement reporting requirements.

• Documents QA data on teams of QA/coders and records findings in the QA system (Guide Audit), which will be for reporting to the client, identifying risk areas, development of training and education programs and development/implementation of standardization within the organization. This also involves guidance and mentorship of coders.

• Helps to ensure that continuing education is planned, scheduled and completed for all coding/QA teams through the coordination of the US.

• Coordinates scheduled quality meetings with the QA and production staff.

• Project Launch - Active involvement in project launch sessions along with team leaders to understand the coding process.

• Have a rotational arrangement and is flexible to work with any given team as assigned.

• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines. -

• Maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes and surgical techniques to effectively apply ICD-9-CM and CPT-4 coding guidelines to inpatient and outpatient diagnoses and procedures.

• Assist with research and development and presentation of continuing education programs on areas of specialization.

• Assist with special projects as required. Example: Focused audits; client launches, etc.

What you will need:

• Minimum of 4 years of experience on medical coding with E&M IP/OP skill

• Should be certified from AAPC/AHIMA

• Hands on experience in E&M audits

• Must be a Graduate

• Ensure data collection capability in relevant systems and business processes

• Strong analytical, research, and organizational skills required.

• ICD-10-PCS coding systems, ensuring accuracy and compliance with all regulatory and reimbursement requirements

What would be nice to have:

• Proficiency in MS Office/excel

• Experience in coding software or encoder (3M, Trucode, Optum)

• Familiarity with EMR systems (EPIC, Cerner, etc.,)

• Knowledge of multiple coding specialties (ED, EM (OP&IP), etc.

What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

About Guidehouse

Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

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