Coding Quality Specialist
Core
Performs complex reviews of clinical documentation on inpatient and outpatient medical records to validate diagnostic and procedural coding accuracy, payment methodology, and reimbursement amounts.
Role type
Senior IC medical coding quality specialist
Builds
Accurate coding assignments and payment methodologies for healthcare providers
Domain
Healthcare administration and medical coding
Required skills
ICD-10-CM/PCS, CPT, HCPCS coding, DRG analysis, coding guidelines interpretation, fraud detection, appeal resolution
Preferred skills
RHIA, RHIT, CCS, CCA, CPC certifications, Health Information Technology degree
Technologies
ICD-10-CM, ICD-9-CM, CPT, HCPCS, DRG
Responsibilities
Review physician clinical documentation for coding accuracy, determine correct payment methodology, develop written rationale for coding findings, identify patterns of possible fraud or abuse, respond to providers for resolution of appeals, conduct periodic peer reviews
Seniority
Mid-level, hands-on IC
