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    • Quality Assurance Specialist - Milwaukee - Accuity

    Accuity
    Accuity Milwaukee

    3 weeks ago

    Default job background
    Description

    Quality Assurance (QA) Specialist

    The Quality Assurance (QA) Specialist plays a critical role in ensuring the accuracy and appropriateness of code assignments for inpatient records. This position is responsible for performing internal coding QA reviews, which provide an additional layer of quality assurance and compliance with official coding guidelines and client facility-specific coding guidelines.

    Key Responsibilities:

    • Perform IP coding quality assurance (QA) reviews to ensure accuracy and appropriateness of code assignments.
    • Maintain turnaround time expectations to minimize impact on client Deferred Billing (DNFB).
    • Stay up-to-date on MS-DRG, APR-DRG, ICD-10 CM/PCS coding and industry-standard clinical indicators, risk factors, and treatment protocols/order sets used in clinical validation of payment-impacting code assignment.
    • Abstract and review medical records to assess documentation against base code sets impacting payment or requested changes in coding.
    • Review scope includes validation of MS-DRGs and APR-DRGs assigned for Medicare, Medicaid, commercial, and third-party claims.
    • Determine when documentation clarification or confirmation queries are necessary.
    • Write query asks with clinical indicators and/or documentation excerpts if discrepancies or gaps exist in medical record documentation and base code assignment per Official Coding Guidelines.
    • Develop a strong understanding of Accuity and client-specific technology, policy, procedures, guidelines, and workflows.
    • Maintain strict confidentiality of patient information.
    • Accountable for meeting or exceeding production and quality expectations.

    Requirements:

    Position Qualifications:

    • Education: High School Diploma or GED required; Associate's degree in health information management or similar preferred.
    • Licensure and/or Credentials/Certifications: Health information management and/or coding credential from AHIMA and/or AAPC required (RHIA, RHIT, CCS, CPC, and/or CIC); CCDS or CDIP certification preferred; AHIMA ICD-10/PCS trainer certification preferred.
    • Experience: Minimum 5 years of hospital inpatient coding experience required; minimum 2 years inpatient/DRG auditing experience required; minimum 2 years inpatient clinical documentation improvement experience preferred.

    Knowledge, Skills, and Abilities:

    • Expert knowledge of Official Coding Guidelines, advanced knowledge of APR and MS DRG reimbursement models, state, and federal regulations.
    • ICD-10-CM/PCS coding expertise including POA assignment and discharge disposition codes.
    • Knowledge of AHRQ Quality Metrics, including patient safety indicators (PSIs), Hospital Acquired Conditions (HACs), Vizient Mortality Models, CMS Core Measures, other national patient safety quality indicators, and different payor categories.
    • Solid command of anatomy, physiology, pathology, laboratory, imaging, pharmacology, disease assessment, patient management, and treatment.
    • Ability to use independent judgment and manage confidential information.
    • Ability to analyze and problem solve.
    • Detail-oriented with ability to multi-task.
    • Strong communication (written and oral) and interpersonal skills.
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Quality assurance specialist