Coding Quality Specialist

This is a remote position.

MFS has an immediate opening for a Remote Coding Quality Specialist for its local healthcare client in Palo Alto, CA. This is a 6 month contract role which may have possibilities of extension and/or conversions in the future. This opportunity comes with competitive pay and great benefits. For instant consideration to this position, Apply Now!

Job Details:

• Shifts Available: Days- 8 hours. 40 hours/week
  
• Hours/Days: 8am-4:30pm; Monday - Friday
  
• On Call: No
  
• How many open positions: 1; temp to permanent opportunity
  
• Length of contract: 6 months with opportunity to extend/convert.
  
• Target Start Date: 1/03/23
  
• Work Location: Fully Remote
  

The Coding Quality Specialist evaluates the adequacy and effectiveness of internal and operational controls designed to ensure that coding processes and practices lead to appropriate execution of regulatory requirements and guidelines related to facility coding including federal and state regulations and guidelines, CMS (Centers for Medicare and Medicaid Services) and OIG (Office of Inspector General) compliance standards. Applies standardized scoring methodology to consistently evaluate coding accuracy and standardizes review findings and methodology to report monitoring results. Communicates review results to department management, coders and other appropriate staff. Makes recommendations to management for corrective action. Serve as a subject matter expert and authoritative resource on interpretation and application of coding rules and regulations and conducts risk assessments of potential and detected compliance deficiencies.

• Adheres to the defined review timeline and coding review protocol standards; assists with development of the monitoring schedule; identifies areas to be reviewed.
  
• Applies consistent and standardized compliance monitoring methodology for sample selection, scoring and benchmarking, development, and reporting of findings.
  
• Conducts risk assessments to define monitoring priorities by evaluating previous findings.
  
• Conducts routine retrospective and prospective facility and technical coding reviews, specialized and focused reviews, and other reviews as directed by the Manager and Director of HIMS Coding and Compliance Department.
  
• Evaluates the appropriateness of ICD-10(International Classification of Diseases), HCPCS (Healthcare Common Procedure Coding System) and CPT (Current Procedural Terminology) codes; evaluates the appropriateness of DRG (Diagnosis-related Group) and admission assignments; evaluates appropriateness of modifier usage; and performs other related analysis and evaluations.
  
• Prepares written reports of review findings and recommendations and presents to management and maintains monitoring records.
  
• Researches, abstracts and communicates federal, state, and payor documentation, and coding rules and regulations; stays current with Medicare, Medi-Cal and other third party rules and regulations, ICD and CPT coding updates, Coding Clinic guidelines; serves as subject matter expert and authoritative resource for the department.
  

Requirements

Education

• High School Diploma or GED equivalent
  

• CCS - Certified Coding Specialist or
  
• RHIT - Registered Health Information Technician or
  
• RHIA - Registered Health Information Administrator or
  
• CPC and/or CCSP - Certified Professional Coder
  

• Three (3) years of progressively responsible and directly related work experience
  
• Will need to take Inpatient Coding Test
  

Knowledge/Skills & Abilities

• Ability to conduct analysis and formulate conclusions
  
• Ability to make effective oral presentations and prepare concise written reports to a variety of audiences
  
• Ability to plan, organize, prioritize, work independently, and meet deadlines
  
• Ability to solve technical and non-technical problems
  
• Ability to work effectively both as a team player and leader
  
• Ability to work well with individuals at all levels of the organization
  
• Knowledge of computer systems and software used in functional area
  
• Knowledge of financial concepts such as capital budgeting, discounted cash flow, financial statement analysis and financial forecasting
  
• Knowledge of TSI decision support systems, database, and other software tools
  

Benefits

• Health
  
• Vision
  
• Dental Insurance
  
• Paid Time Off
  
• 401k (Upon Qualifying)