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Inpatient Coding Quality Reviewer - All

R1RCM - Milwaukee, Wisconsin

Posted: 09/3/2018

Shift Days: M - F; Shift Hours: Flexible

Set your sights on a role making a real difference in the healthcare system. We’re looking for a self-motivated Inpatient Coding Quality Reviewer professional to join our team. We have a relentless focus on driving results for our customers and enabling them to invest more into patient care; in turn, this allows us to continue to grow our company and your career.

The Inpatient Coding Quality Reviewer will be responsible for reviewing inpatient coded cases for coding completeness and accuracy.  This position identifies potential coding and DRG errors, researches appropriate guidelines to support recommended changes, and communicates the changes to the coder involved on a timely basis. The Reviewer provides expert coding advice to coding staff and relays needed coding educational topics to the Regional Manager, IP Coding Quality. This person will conduct daily pre-bill review of cases flagged by the PwC SMART coding quality monitoring software tool, maintain required productivity standards and high quality results.  This role will report to the Regional Manager of Inpatient Coding Quality.

Your day to day role will include:

  • Audits records as defined in the coding audit plan.
  • Audits cases flagged by the coding quality software on a daily basis for multiple hospitals, including validating the completeness of documentation, identifying diagnoses and procedures that have been missed, proposing physician queries, and ensuring the accuracy of diagnoses, procedures, POA, discharge disposition and DRG assignment. 
  • Follows, and maintains up-to-date knowledge of, industry coding and documentation guidelines (e.g., Official ICD-10 Coding and Billing Guidelines, Coding Clinic advice, R1 and Ascension coding policies and procedures, and AHIMA/ACDIS Query Guidelines) so as to maintain system-wide coding consistency and remain in compliance with governmental and other regulatory guidelines.
  • Communicates audit findings with coders in a timely manner and supports the teams in effectively and efficiently addressing and resolving local coding issues.
  • Maintains both a high productivity rate and a high accuracy rate in accordance with established auditing standards.
  • Serves as an inpatient coding expert & resource for the coding teams and other departments.
  • Works with the Regional Manager to identify areas of educational need based on audit results.
  • Reports to, and works with, the Regional Manager to identify improvements in the audit software tool, workflow processes and flag management; and assist with evaluation and testing of audit applications and updates as needed.
  • Work with the hospital’s CDI team to address and resolve documentation issues.
  • Assists with compilation, generation and analysis of data for results reporting and performance Improvement initiatives.
  • Contributes to the reduction of the hospital's and Company’s coding compliance risks and contributes to the Company’s revenue enhancement goals.
  • Maintains an open dialogue and a good working relationship with team members in order to advance the mission and objectives of the hospitals and R1.
  • Assists with training of new auditors.
  • Assists with other audits and duties as requested.
 You Have:

  • Bachelor's Degree in Health Information Management with RHIA or RHIT and CCS credentials.
  • Bachelor's or Associates Degree with CCS credential is required.
  • A minimum of seven (7) years of hospital inpatient coding experience is required.
  • Extensive knowledge of ICD-10-CM/PCS classification system and MS- DRG and APR-DRG methodologies is required.
  • In-depth knowledge of medical terminology, human anatomy/physiology, pharmacology, and pathology is required.
  • Expert and up-to-date knowledge of industry Official Coding and Reporting Guidelines along with CMS and other agency directives for ICD-10 coding.
  • Must have proficient MS Office computer skills, specifically in Excel and knowledge of various coding software/platforms and EMRs.
  • Must be detail-oriented and have the ability to work independently and maintain a high productivity rate and coding accuracy rate.
  • Ability to interact with other employees through effective communication
  • Must be a self-starter.

It would be great if you also have:

  • Two (2) years of inpatient coding audit experience is preferred.
  • Experience in a large (> 500 beds) hospital or multi-hospital health system is preferred.
  • Training in hospital Clinical Documentation Improvement is preferred.
  • Experience as a Coding Consultant with a consulting firm is preferred.

We offer:                                      

R1 is changing healthcare by infusing operational discipline and proprietary technology in hospital financial processes. We are an industry leader; we are the only independent organization with a comprehensive service and technology offering for hospital revenue cycle management, and we have achieved leading outcomes for our customers.

  • A strong financial performing, growing organization that will keep you on your toes with new ideas, changes and opportunities to learn and grow in abundance.
  • A culture of excellence, driving customer success so they can focus on improving patient care and on giving back to the community.
  • A Total Rewards package which may include such things as: competitive compensation package, the ability to choose from a comprehensive benefit program mostly funded by R1 that includes medical, dental, vision, flexible spending accounts, commuter benefits, life and disability insurance, along with work life balance programs including paid time off for personal time, illness and volunteering, and we offer a retirement savings plan and continuing training and development and so much more!

Sound like you? Let’s talk!

About R1:

R1 is a leading provider of revenue cycle management services and Physician Advisory Services to healthcare providers.  We are the largest independent end-to-end revenue cycle provider and have the longest operating history in the revenue cycle industry.  R1’s objective is to be the one trusted partner to manage revenue so providers and patients can focus on what matters most.  Our distinctive operating model and values includes people, processes, and sophisticated integrated technology/analytics that help customers realize sustainable improvements in their operating margins and improve the satisfaction of their patients, physicians, and staff.  We are dedicated to transforming the commercial infrastructure and patient experience in healthcare.

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