US-Coding Assoc III

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration.   

The Inpatient Coding Quality Reviewer will be responsible for reviewing inpatient coded cases for coding completeness and accuracy. This person will identify 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 role will report to the Regional Manager of Inpatient Coding Quality. 

Here’s what you will experience working as a (Inpatient Coding Quality Reviewer):    

• Review inpatient coded cases for coding completeness and accuracy. 

• Identify potential coding and DRG errors, research appropriate guidelines to support recommended changes, and communicate changes to the coder involved on a timely basis. 

• Provide expert coding advice to coding staff and relay needed coding educational topics to the Regional Manager, IP Coding Quality. 

• 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. 

• Audit records as defined in the coding quality review plan. 

• Review cases flagged by the coding quality software on a daily basis for multiple hospitals. 

• Validate the completeness of documentation, identify missed diagnoses and procedures, propose physician queries, and ensure the accuracy of diagnoses, procedures, POA, discharge disposition, and DRG assignment. 

• Perform retrospective coding quality reviews as requested. 

• Maintain up-to-date knowledge of industry coding and documentation guidelines to ensure system-wide coding consistency and compliance. 

• Communicate audit findings with coders in a timely manner and support teams in addressing and resolving local coding issues. 

• Serve as an inpatient coding expert and resource for the coding teams and other departments. 

• Work with the Regional Manager to identify areas of educational need based on audit results. 

• 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. 

• Assist with compilation, generation, and analysis of data for results reporting and performance improvement initiatives. 

• Contribute to the reduction of the hospital's and Company’s coding compliance risks and revenue enhancement goals. 

• Maintain an open dialogue and a good working relationship with team members. 

• Assist with training of new auditors and other audits and duties as requested. 

Required Skills:  

• Bachelor's or Associate's Degree with CCS credential. 

• A minimum of seven (7) years of hospital inpatient coding experience. 

• Extensive knowledge of ICD-10-CM/PCS classification system and MS-DRG and APR-DRG methodologies. 

• In-depth knowledge of medical terminology, human anatomy/physiology, pharmacology, and pathology. 

• Expert knowledge of industry Official Coding and Reporting Guidelines, CMS, and other agency directives for ICD-10 coding. 

• Proficient MS Office computer skills, specifically in Excel, and knowledge of various coding software/platforms and EMRs. 

• Detail-oriented with the ability to work independently and maintain a high productivity rate and coding accuracy rate. 

• Effective communication skills and a self-starter attitude. 

Desired Qualifications: 

• Two (2) years of inpatient coding audit experience. 

• Experience in a large (> 500 beds) hospital or multi-hospital health system. 

• Training in hospital Clinical Documentation Improvement. 

• Experience as a Coding Consultant with a consulting firm.