Inpatient Coding Quality Officer I - (All Other Payer)

The Quality Officer 1 is responsible for ensuring the accuracy and integrity of ICD-10-CM/PCS coding and DRG assignment for inpatient encounters for other payers (not Medicare/Managed Medicare). This role requires critical thinking and a skill set above that of a typical coder. Quality Officers must also maintain an excellent organizational average accuracy rate and adhere to applicable Federal and State Regulations, Compliance Guidelines, and Coding Guidelines set forth by RWJBH, AHA, and AMA.

Qualifications:

• Bachelor's degree or equivalent experience.
• 4+ years acute care coding and/or auditing experience with a Bachelor's degree.
• 7+ years acute coding and/or auditing experience required without a Bachelor's degree.
• Extensive knowledge of ICD-10-CM/PCS and CPT coding, medical terminology, human anatomy and physiology, clinical indicators, and pharmacology.
• Knowledge of billing and coding regulations.
• Excellent interpersonal, oral, and written communication skills.
• Strong critical thinking and analysis skills.
• Excellent organizational and time management skills.
• Professional demeanor and ability to work independently and as part of a team.

Certifications and Licenses Required:

• CCS certification required.
• Proficiency in ICD-10-CM/PCS required.

Preferred:

• CPC-H, RHIT, RHIA, and/or RN certifications encouraged.

Scheduling Requirements:

• Primarily remote position with occasional onsite requirements.

Essential Functions:

• Ensure accuracy and integrity of coding and DRG assignment, adhering to regulations and guidelines.
• Analyze inpatient records to apply appropriate coding, DRG judgments, SOI, ROM, and POA.
• Manage SMART queues for all facilities, reviewing and directing records as flagged.
• Manage EPIC SMART WQ's to ensure proper workflow.
• Guide and educate coders on coding principles, code assignment, and clinical disease processes.
• Maintain high accuracy rates and improve coding practices.
• Review and analyze coding decisions, monitor quality scores, and address discrepancies.
• Meet productivity standards and monitor queues to ensure timely review and release of records.
• Collaborate with the coding team to meet review goals.
• Review demographic and clinical information for accuracy and completeness.
• Report system issues to IT support.
• Maintain records of review activities and communicate recommendations clearly.
• Perform regulatory coding research as needed.
• Perform other duties as assigned.

RWJBarnabas Health offers a comprehensive benefits package including PTO, insurance options, retirement plans, tuition reimbursement, wellness programs, and more. We are committed to providing high-quality, patient-centered care and fostering a supportive work environment. We value diversity and are an Equal Opportunity Employer.