Coding Quality Auditor and Specialist, HB Coding, Full-time, Days (Remote)

The  Coding Quality Auditor and Specialist reflects the mission vision and values of NM adheres to the organizations Code of Ethics and Corporate Compliance Program and complies with all relevant policies procedures guidelines and all other regulatory and accreditation standards.  The Coding Quality Auditor and Specialist is required to be the expert in the work related to clinical documentation and coding.  This position works in tandem with the Clinical Documentation Team assuring quality metrics are held to the highest standard for NM Health System.

The Coding Quality Auditor and Specialist is responsible for assuring coding guidelines and regulations are not compromised during the decision-making process related to clinical documentation and the coding of this documentation.  This position partners with Clinical Documentation Nurses Physicians and other licensed providers to improve the quality of documentation assuring best quality performance and representation of care addition the Coding Quality Auditor and Specialist collaborates with the CMOs to ensure the integrity of the Health Record is established through best practices in Clinical Documentation and Coding.

The Coding Quality Auditor and Specialist is responsible for maintaining quality work queues and quality reports advanced and complex project work that includes but is not limited to Risk Adjustment Mortality Review Hospital Acquired Condition (HAC) and Patient Safety Indicator (PSI) Review Quality Abstraction and Analysis and/or special and non-traditional project work. Incumbents to this role have a mastery of advanced clinical documentation integrity and quality concepts coupled with the ability to consistently identify root causes and deliver measurable results. Key to this role is the ability to lead and facilitate quality initiatives and external rankings initiatives while remaining compliant within the coding guidelines and regulations.

The Coding Quality Auditor and Specialist solves complex problems and adds new perspectives to existing solutions. The Coding Quality Auditor and Specialist applies advanced knowledge of the national quality agenda and clinical documentation integrity and coding compliance to advance problem analysis and creative process redesign for Northwestern Medicine.

 This position is 100% remote (occasional onsite meeting attendance may be requested)

Responsibilities:

• Collaborates with clinical documentation team in the review of inpatient accounts (with an emphasis on mortality reviews) identifying documentation improvement opportunities
• Assess DRG PDx secondary Dx PCS POA and all other components of documentation that impact quality metrics
• Consistently assures coding practices remain compliant with coding guidelines and regulations
• Continually identifies educational opportunities related to coding and documentation
• Expert educator to clinical teams and medical staff
• Identifies strategic plans that will result in a positive impact to the clinical dashboard
• Develops clinical relationships across the health system securing interdepartmental support necessary for successful implementation of education strategies assuring achievement of overall strategic targets
• Ability to multi-task a variety of audits
• Ability to analyze data and construct appropriate action plans
• Develops teaching tools to promote quality outcomes
• Is an active member of clinical and executive meetings as identified
• Advanced understanding of quality metrics for health system (Vizient PSI USNWR)
• Advanced understanding of clinical documentation and coding through the lens of local and national quality and ranking methodologies including but not limited to U.S News and World Report Vizient Leapfrog the CMS Star Rating and payer contracts and assists the Managers of Clinical Documentation and Coding in implementing key strategies to effect change.
• Partners with Coding Clinical Documentation leadership and Medical Directors to coordinate maintain and execute advanced project work that includes but is not limited to Mortality Review HAC/PSI Review Quality Abstraction and Analysis and/or special and non-traditional project work.
• Partners with NM departments that includes but is not limited to: IT; Analytics; and Innovation to design and implement new and advanced workflow solutions.
• Partners with third-party consultants/partners to contribute to workflow and methodology build and refine as necessary.

Qualifications :

Required:

• RHIT or RHIA or CCS Certification
• Certified Clinical Documentation Specialist
• Bachelor Degree Healthcare field related OR completion of an Associates Degree with five plus years of healthcare coding experience.
• Clinical expertise and understanding achieved through prior experience working with clinical documentation teams
• Strong personal computer skills (Word Excel PowerPoint Visio)
• Excellent verbal written and presentation skills
• Demonstrates critical thinking skills
• Excellent interpersonal skills
• Planning and time management skills
• Educational/training experience

Preferred:

• Masters Degree in related field or currently enrolled in Masters program

Additional Information :

Northwestern Medicine is an equal opportunity employer (disability VETS) and does not discriminate in hiring or employment on the basis of age sex race color religion national origin gender identity veteran status disability sexual orientation or any other protected status.

Background Check

Northwestern Medicine conducts a background check that includes criminal history on newly hired team members and at times internal transfers. If you are offered a position with us you will be required to complete an authorization and disclosure form that gives Northwestern Medicine permission to run the background check.  Results are evaluated on a case-by-case basis and we follow all local state and federal laws including the Illinois Health Care Worker Background Check Act.

Artificial Intelligence Disclosure

Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position however all employment decisions will be made by a person. 

Benefits

We offer a wide range of benefits that provide employees with tools and resources to improve their physical emotional and financial well-being while providing protection for unexpected life events. Please visit our Benefits section to learn more.

Sign-on Bonus Eligibility: Internal employees and rehires who left Northwestern Medicine within 1 year are not eligible for the sign on bonus. Exception: New graduate internal employees seeking their first licensed clinical position at NM may be eligible depending upon the job family. 

Remote Work :

Yes

Employment Type :

Full-time