Coding Quality Reviewer

Role Overview

As a Coding Quality Review (CQR) Specialist, you will operate in a work-from-home environment supporting all CQR team-related systems and tools. You will perform internal quality assessment reviews on Health Information Management Service Center (HSC) coders to ensure compliance with national coding guidelines, HSC coding policies, and company policies for complete, accurate, and consistent coding, resulting in appropriate reimbursement and data integrity.

Job Responsibilities

• Lead, coordinate, and perform all functions of quality reviews (routine, pre-bill, policy-driven, and incentive plan-driven) for inpatient and outpatient coding across multiple HSCs.
• Assist in ensuring HSC coding staff adherence to coding guidelines and policy.
• Demonstrate and apply expert-level knowledge of medical coding practices and concepts.
• Participate in special reviews or projects.
• Maintain or exceed 95% productivity standards.
• Maintain or exceed 95% accuracy.
• Meet all educational requirements as stated in current company policy.
• Review all official data quality standards, coding guidelines, company policies and procedures, and clinical/medical resources to ensure coding knowledge and skills remain current.

Qualifications

• Undergraduate degree in HIM/HIT preferred (Associate's or Bachelor's).
• RHIA, RHIT mandatory.
• IP Coding Auditor for MS-DRG.
• Must have experience in all body systems (cannot be specialized in one area, e.g., Orthopedic).
• Must have 3 years of hands-on coding MS-DRG auditing in a hospital setting.
• Cannot be a recent graduate; needs experience, ideally 10+ years of coding and 3 years of auditing in MS-DRG Inpatient medical records.

Additional Information

• We cannot employ candidates who reside in California, Alaska, New York, or Colorado for any of our work-from-home positions.
• Candidates will be expected to complete a coding test (20 Multiple Choice/True/False and 5-7 Open-ended Behavioral questions; 90 minutes long).
• FTEs: 4