Inpatient Coding Quality Reviewer- Hospital

at Guidehouse in Springfield, Illinois, United States

Job Description

Job Family :

General Coding

Travel Required :


Clearance Required :


What You Will Do:

The Coding Quality Reviewer shall report directly to the Internal Quality Control Director and will be responsible for accessing and reviewing the medical record documentation, coding and abstracting accuracy as defined in quality review policies and facility guidelines utilizing ICD-10 CM/PCS and CPT coding classification systems. Review of patient records will be conducted utilizing the facility EMR, scanning technology and/or other established methods. All reviews will be entered daily into Guidehouse proprietary quality review tracking and trending software and will respond to coder rebuttals in a timely manner (timeline defined in quality review policies and procedures). Will also write appeals letters based on clinical validation. This position will perform any and all related job duties as assigned. This position is 100% remote.

+ Ensure coding quality review percentage or number of accounts per coder (as noted review assignment list) for each coder’s work is conducted monthly for facilities the reviewer is assigned.

+ Coding quality review will be conducted to identify abstracting (to include dc disposition and POA indicators), ICD-10-CM, ICD-10-PCS, CPT, modifier, and HCPCS coding errors for codes assigned by the coding team (see quality review policies for review details).

+ Reviewer will run coder productivity reports (where applicable) to pull random sample accounts for review and to ensure review numbers or percentages are met

+ Review coding and abstracting (as defined by the facility/client) on patient types assigned to review: inpatient, ambulatory surgery, observation, emergency room with or without E/M levels, clinic, ancillary, diagnostics, etc to assure 95% coder accuracy (or as stipulated by client contract).

+ Become familiar with any facility specific coding guidelines and know where to access.

+ Required to read all Coding Clinics and CPT Assistant updates published by the education team and stay abreast of all new coding guidelines.

+ Ensure code recommendations entered into GuideAudit are supported by quoting AHA official Coding guidelines, Coding Clinics, CPT Assistant and/or other official coding references. Reviewers shall also document the specific record documentation that supports any code recommendation.

+ Notify each coder when monthly review has been completed and respond to coder rebuttals in timely manner (see quality policy and procedures for required timeline requirements)

+ Communicate in a professional, educational, non-threatening mentorship manner with the coding team in coding quality recommendations and rebuttal discussions.

+ Follow review escalation policy when coder/reviewer disagreements occur (see quality review policy/procedures).

+ Assist Coders in answering coding/abstracting questions resulting from quality reviews.

+ Conduct pre-bill audits for new Coders

+ Conduct coder intensification reviews for Coders who fall below the stipulated accuracy rate as part of the corrective action plan (per guidance of Review Supervisor or IQC Director)

+ Maintain working knowledge of ICD-10-CM/PCS and CPT coding principles, government regulations, official coding guidelines, and third-party requirements regarding documentation and billing.

+ Assist as needed in the review of external coding audit company findings and assist in in formulating a response as requested

+ Participate in client conference calls and mandatory monthly quality team stand-up calls. Responsible to review the minutes of monthly quality stand up calls if not able to dial into the conference call (minutes are posted on the portal).

+ Provide company support for the creation, maintenance and ongoing operation of an efficient and accurate Quality Improvement Plan that is compliant with Local, State, and Federal Government Regulations.

+ Work with the Coding Solutions Division to provide on-going coding education resulting from the Quality Reviews when requested

+ Maintain open lines of communication serving as a liaison between client, Coders, and Coding Solutions Division to ensure that all parties are kept up to date on specific hospital guidelines/policies.

+ Participate in company Coding Solutions Division Meetings as requested.

+ Reviewers are responsible for maintaining HIPAA compliant workstations (reference HIPAA work station policy).

What You Will Need:

+ Must hold one of the following active credentials: (RHIT, RHIA, CCS or CIC)

+ Must have at a minimum three years of coding or review experience for the type of work being assigned.

I nformation System Requirements:

+ Computer and monitors provided by Guidehouse.

+ Internet Access with DSL or high-speed connectivity (supplied by employee).

+ Remote office location that meets HIPAA privacy requirements.

What Would Be Nice To Have:

+ Pre-bill audit experience

+ Experience writing appeals letters based on clinical validation


\#LI- Remote

The annual salary range for this position is $63,200.00-$113,800.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

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.

Benefits include:

+ Medical, Rx, Dental & Vision Insurance

+ Personal and Family Sick Time & Company Paid Holidays

+ Position may be eligible for a discretionary variable incentive bonus

+ Parental Leave

+ 401(k) Retirement Plan

+ Basic Life & Supplemental Life

+ Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts

+ Short-Term & Long-Term Disability

+ Tuition Reimbursement, Personal Development & Learning Opportunities

+ Skills Development & Certifications

+ Employee Referral Program

+ Corporate Sponsored Events & Community Outreach

+ Emergency Back-Up Childcare Program

About Guidehouse

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, 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.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

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Job Posting: JC248680904

Posted On: Sep 28, 2023

Updated On: Jan 08, 2024

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