Coding Quality Reviewer Auditor

003306

This is a Hospital Based coding position PCS not a Professional Fee Coder position PCT.

PRIMARY FUNCTION:

Under the direction of Coding Management, the coding quality reviewer is responsible for the review of medical records to assure the accuracy of codes assigned for outpatient/inpatient medical records according to CPT-4 and/or ICD-10-CM/PCS coding rules and principles and supports a complete and accurate clinical and financial database. Perform quality assurance audits where directed. Compiles results and summary findings of reviews for management review and trending analysis. Prepares presentations and attends Committee meetings to review results. Interacts with Providers and Hospital Departments related to coding guideline education. Delivers feedback to the coding team for educational purposes.

1. Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson

2. Reviews coded records, analyzes, interprets and classifies clinical information in the medical record according to ICD-10-CM/PCS and/or CPT coding rules and principles. Abides by the Standards of Ethical Coding as set forth by the American Health Information
3. Conducts review of coded records according to quality measures, risk variables and other specific documentation criteria, provides statistical analysis of error rates prior to bill processing. Share finding with coding staff for education. Forwards trends to
bull; Extensive knowledge of medical terminology, human anatomy and physiology, and clinical disease process required.bull; At least 10 years coding experience. bull; Knowledge of official coding guidelines and common billing regulations.
bull; Associate Degree or BS in Health Information Management, Nursing or related field.
bull; Knowledge of performance benchmark databases and risk variables such as Vizient, Publically reported clinical and claims data and regulatory quality measures.
4. Attend hospital quality and service line committee meetings to represent the Coding Department as it relates to agenda items for coding review results and coding guidelines education.
5 Prepare compliant queries to physicians and other clinical providers when documentation in the medical record is inadequate, ambiguous, or unclear for coding purposes.
Please indicate current title of job and job code if possible:
Under the direction of Coding Management, the coding quality reviewer is responsible for the review of medical records to assure the accuracy of codes assigned for outpatient/inpatient medical records according to CPT-4 and/or ICD-10-CM/PCS coding rules and principles and supports a complete and accurate clinical and financial database. Perform quality assurance audits where directed. Compiles results and summary findings of reviews for management review and trending analysis. Prepares presentations and attends Committee meetings to review results. Interacts with Providers and Hospital Departments related to coding guideline education. Delivers feedback to the coding team for educational purposes.
6 Participate in all Coding Department inservice meetings or training

Jefferson includes Thomas Jefferson University and Jefferson Health, a dynamic university and health system with broad reach across the Delaware Valley. Jefferson is the second largest employer in Philadelphia and the largest health system in Philadelphia based on total licensed beds.

Through the merger of Thomas Jefferson University and Philadelphia University in 2017, our University includes ten colleges and four schools. We are an NCAA Division II university and an R2 national doctoral university offering undergraduate and graduate-level programs that provide students with a forward-thinking education in architecture, business, design, engineering, fashion and textiles, health, medicine and social science.

Jefferson Health, the clinical arm of Thomas Jefferson University, has grown from a three-hospital academic health center in 2015, to an 18-hospital health system through mergers and combinations that include hospitals at Abington Health, Aria Health, Kennedy Health, Magee Rehabilitation and Einstein Healthcare Network. We have over 50 outpatient and urgent care centers; ten Magnetreg;-designated hospitals (recognized by the ANCC for nursing excellence); the NCI-designated Sidney Kimmel Cancer Center (one of only 70 in the country and one of only two in the region); and one of the largest faculty-based telehealth networks in the country. In 2021, Jefferson Health became the sole owner of HealthPartners Plan, a not-for-profit health maintenance organization in Southeastern Pennsylvania. We are the first health system regionally to create an aligned payer-provider partnership.

Jeffersonrsquo;s mission, vision and values create an organization that attracts the best and the brightest students, faculty, staff, and healthcare professionals, as well as the most visionary leaders to drive exceptional results.

• OUR MISSION: We improve lives.
• OUR VISION: Reimagining health, education and discovery to create unparalleled value
• OUR VALUES: Put People First, Be Bold amp; Think Differently and Do the Right Thing

As an employer, Jeffersonmaintains a commitment to provide equal access to employment. Jefferson values diversity and encourages applications from women, members of minority groups, LGBTQ individuals, disabled individuals, and veterans.