QA for Medical Coding

JOB SUMMARY
Responsible for maintaining accurate audits of accounts processed by the associate. Quality Assurance Specialist (QA Specialist) ensures compliance with industry standards and client-specific guidelines. QA Specialist monitors, tracks, and trends audit findings to be shared with the management team (Operations, Training, and Quality). QA Specialist collaborates with the management team in providing actionable measures to maintain and/or improve the quality of the associate and the team.

PRIMARY RESPONSIBILITIES

• Participates in the design of quality monitoring formats and quality standards.
• Participates in meetings and training sessions with the management team (Training & Quality, Operation) and with the client that is relevant to quality initiatives and improvement.
• Able to compile and track the performance of the team and associate level.
• Performs quality audits and provides trends based on the data to the management team.
• Provides findings, recommendations, and action plans based on the quality audits to the management team (Operations, Training & Quality).
• Coordinates and facilitates calibration sessions for associates and management team (Operations, Training & Quality).
• Provides feedback and/or coaching sessions to associates accordingly.
• Prepares and analyzes internal and external quality reports to provide insights into quality improvement.
• Stays current with Official Coding and Reporting Guideline, payer-specific guidelines, CMS directives for ICD 10 coding and conducts intensive research for an acceptable source of references in accurate audit and feedback to coders.
• Keeping updated to facility-specific guidelines and compliance to ensure accuracy in auditing.
• Adhere to the individual company's Compliance Guideline Policy and Procedure memos as distributed.
• Adheres to HIPAA privacy and security policies and practices.
• Other tasks/functions that may be assigned by the company as per business requirements (such as participating in doing the production and provide training to new hires during critical days); may change from time to time to reflect the changing requirement of your position and our business.

QUALIFICATIONS & COMPETENCIES

• At least 2 years of coding experience.
• At least One year of auditing experience
• With certification in CCS, CCS-P, CCA, CPC, COC, CIC
• Knowledge of medical terminologies, anatomy and pathophysiology
• Must be able to maintain the strictest confidentiality
• Has analytical, problem-solving/decision-making skills
• Ability to multitask
• Detail-oriented and Microsoft Office proficient
• Proficient typing skills
• Good communication, organizational, interpersonal and presentation skills
• Can work with minimal supervision
• Exhibits being proactive and team player
• Flexible to work in shifting & graveyard schedules
• Good time management and prioritization skills
• Must adapt well to changes.