Professional Services – Medical Coding Quality Assurance Specialist

Our goals are to provide excellent service, utilize advanced technology, and proficiently deliver results. To accomplish these goals, we constantly seek individuals who look for ways to do things better. We are a company whose culture cultivates teamwork, rewards excellence, focuses on quality for every aspect of our business, and promotes community involvement.

Tabula Rasa HealthCare (TRHC) is a leader in providing patient-specific, data-driven technology and solutions that enable healthcare organizations to optimize performance to improve patient outcomes, reduce hospitalizations, lower healthcare costs, and manage risk. Medication risk management is TRHC’s lead offering, and its cloud-based software applications, including EireneRx® and MedWise™, provide solutions for a range of payers, providers and other healthcare organizations.

TRHC empowers our employees to provide excellent service, utilize advanced technology, and proficiently deliver results. Our 32Fundamentals are what we are and who we are. Our culture cultivates teamwork, rewards excellence, focuses on quality for every aspect of our business, and promotes community involvement. As a part of our team, you will help us bring innovative service models to healthcare, improving patient outcomes.

We are seeking a Medical Coding Quality Assurance Specialist. This position performs highly technical and specialized functions for Capstone. The Medical Coding Quality Assurance Specialist performs quality audits for coding data to ensure compliance with Coding guidelines, as well as departmental policies and procedures. The primary function of this position is to ensure compliance in maintaining 95% coding accuracy for all coding staff. Additionally, this position analyzes findings and provides feedback and support for training and clinical documentation improvement.

POSITION RESPONSIBILITIES

Primary Functions:

• Performs validation audits and interpretation of medical documentation to ensure capture of all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives.
• Performs quality reviews of coding vendor and/or coding team work activities to ensure all collected data is accurate, complete, and compliant with state and federal regulations as well as Official Guidelines for Coding and Reporting and Capstone defined coding policies and procedures.
• Abstracts all necessary information from health records to identify secondary complications and co-morbid conditions.
• Identifies and reports issues or errors, such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, or codes that do not conform to approved coding guidelines and CMS HCC Categories
• Assigns and sequences ICD codes to diagnoses for documented information. Performs final review and revision of ICD-10 codes in Client’s EMR. May perform ICD-10 code entry when necessary into client’s EMR.
• Maintains 95% accuracy rate.
• Appropriately uses coding principles to code to the highest specificity and complies with CMS regulations and company goals and policies.
• Upon completion of audits, compiles detailed findings and prepares reports.
• Provides audit results and shares recommendations for course-correction and education as needed. Analyzes coded data to determine trends and root cause for variations.
• Performs reviews for prospective and retrospective audits when requested.
• Participates in workgroups/committee meetings and process improvement solutions as required.
• Advises Director of Coding and Auditing of possible trends in inappropriate utilization (under and/or over) and other quality of care issues.
• Maintains professional license and certifications and attends training conferences/webinars as necessary to keep abreast of latest trends in the field of expertise.

Qualifications:

Education and Certifications:

Required:

• Certified Coding Specialist designation (CCS) issued by the American Health Information Management Association; or, Certified Professional Coder (CPC) or Certified Technologist (RHIT)

Experience and Training:

Minimum 3 years coding experience (except RHIT) with a minimum of 2 years’ experience with Risk Adjustment Coding (HCC)

The Company is proud to be an equal opportunity employer. All qualified applicants will receive consideration without regard to ancestry or national origin, race or color, religion or creed, age, disability, AIDS/HIV, gender, marital or family status, pregnancy, childbirth or related medical conditions, genetic information, military service, protected caregiver obligations, sexual orientation, protected financial status or other classification protected by applicable law.

Other details

• Pay Type Salary

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