RWJBarnabas Health
Job Title
HIM Coding Quality Officer III – Remote Req #:
0000221717 Category:
Information Systems and IT Status:
Full-Time Shift:
Day Facility:
RWJBarnabas Health Corporate Services Department:
HIM - Coding Quality Pay Range:
$87,313.00 - $123,330.00 per year Location:
2 Crescent Place, Oceanport, NJ 07757 (Remote; candidates must be based in New Jersey, New York, or Pennsylvania) Job Overview
The Quality Officer III is responsible for ensuring accuracy and integrity of ICD-10-CM/PCS coding and DRG assignment for inpatient Medicare encounters, sustaining an excellent organizational average accuracy rate. Adherence to applicable Federal and State Regulations, Compliance Guidelines, and Coding Guidelines set forth by RWJBH, American Hospital Association (AHA) and the American Medical Association (AMA) must be maintained. Qualifications
Required: Bachelor's degree and 5+ years experience within acute care coding and/or auditing with a concentration on inpatient Medicare records or 9+ years of experience within acute care coding and/or auditing with a concentration on inpatient Medicare records in lieu of a Bachelor's degree Extensive knowledge of ICD-10-CM/PCS and CPT coding, medical terminology, human anatomy and physiology, clinical indicators associated with disease processes and pharmacology Knowledge of Medicare and Medicaid billing and coding regulations Excellent interpersonal, oral and written communication skills Excellent organizational and time-management skills Must be able to work independently and cooperatively with minimal supervision Preferred: CPC‑H, RHIT, RHIA and/or RN licensure Certifications and Licenses Required
CCS certification Scheduling Requirements
Shift: 8:00am – 4:30pm, Monday‑Friday Full Time Remote Essential Functions
Ensures the accuracy and integrity of ICD-10-CM/PCS, CPT coding when applicable and DRG assignment for adherence to Federal and State Regulations and Compliance Guidelines Critically analyzes each Medicare inpatient medical record to apply appropriate coding, DRG judgments, SOI, ROM and POA Independently manages SMART pending queues for all acute care RWJBarnabas facilities, reviewing ICD-10-CM/PCS coding and DRG assignment of medical records flagged by SMART Independently manages EPIC SMART WQ’s to assure proper workflow of identified accounts Directs coders with appropriate case‑specific recommendations. Educates and coaches coders in the application of coding principles, code assignment and sequencing, DRG assignment and clinical disease processes Sustains an excellent organizational average accuracy rate by leveraging advanced knowledge of coding practices The Quality Officer's coding analysis is reviewed by the Coding Specialists biannually; incorrect judgments affecting the DRG may result in increased monitoring until quality scores of 90% or better for two consecutive months are obtained Productivity Standards must be met for all Quality Officers; failure to meet standards will result in progressive disciplinary action Provides guidance to Quality Officer 1 and 2 as requested Independently monitors SMART queues to ensure all records imported by SMART are reviewed and properly directed, released to billing as appropriate and within department timelines Works as a team with other Quality Officers to ensure SMART review goals are met for all RWJBarnabas facilities May review ICD‑10‑CM/PCS coding associated with RAC audits and/or other additional medical records as needed, providing appropriate written feedback including rationale, research, and coding guidelines to management and/or the Coding Specialists Reviews Discharge Status, Admission and Discharge Dates, and other related demographic information coded and entered by affiliate staff for accuracy and completeness, communicating need for Case Management review when appropriate Reviews Present on Admission (POA) indicators for all diagnosis coded and entered by coders for accuracy and completeness Reviews Physician Queries submitted by staff for necessity, accuracy and completeness and communicates recommendations to sites as appropriate Participates in the review of other payers as directed Independently reports problems with any and all computer system to RWJBarnabas IT&S or SMART helpdesk for resolution May perform classroom training in ICD‑10‑CM/PCS and CPT coding for affiliate staff when needed at the internal RWJ Barnabas Coding School that may be held to train new facility coders Maintains proper computer and written records of all review activity Effectively communicates coding recommendations and rationale to Coding team Performs regulatory coding research as needed Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. Benefits and Perks
Paid Time Off including Vacation, Holidays, and Sick Time Retirement Plans Medical and Prescription Drug Insurance Dental and Vision Insurance Disability and Life Insurance Paid Parental Leave Tuition Reimbursement Student Loan Planning Support Flexible Spending Accounts Wellness Programs Voluntary Benefits (e.g., Pet Insurance) Community and Volunteer Opportunities Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon …and more! Choosing RWJBarnabas Health!
RWJBarnabas Health is the premier health care destination providing patient-centered, high-quality academic medicine in a compassionate and equitable manner, while delivering a best-in-class work experience to every member of the team. We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time. As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health. RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey—whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education. Equal Opportunity Employer
RWJBarnabas Health is an Equal Opportunity Employer.
#J-18808-Ljbffr
HIM Coding Quality Officer III – Remote Req #:
0000221717 Category:
Information Systems and IT Status:
Full-Time Shift:
Day Facility:
RWJBarnabas Health Corporate Services Department:
HIM - Coding Quality Pay Range:
$87,313.00 - $123,330.00 per year Location:
2 Crescent Place, Oceanport, NJ 07757 (Remote; candidates must be based in New Jersey, New York, or Pennsylvania) Job Overview
The Quality Officer III is responsible for ensuring accuracy and integrity of ICD-10-CM/PCS coding and DRG assignment for inpatient Medicare encounters, sustaining an excellent organizational average accuracy rate. Adherence to applicable Federal and State Regulations, Compliance Guidelines, and Coding Guidelines set forth by RWJBH, American Hospital Association (AHA) and the American Medical Association (AMA) must be maintained. Qualifications
Required: Bachelor's degree and 5+ years experience within acute care coding and/or auditing with a concentration on inpatient Medicare records or 9+ years of experience within acute care coding and/or auditing with a concentration on inpatient Medicare records in lieu of a Bachelor's degree Extensive knowledge of ICD-10-CM/PCS and CPT coding, medical terminology, human anatomy and physiology, clinical indicators associated with disease processes and pharmacology Knowledge of Medicare and Medicaid billing and coding regulations Excellent interpersonal, oral and written communication skills Excellent organizational and time-management skills Must be able to work independently and cooperatively with minimal supervision Preferred: CPC‑H, RHIT, RHIA and/or RN licensure Certifications and Licenses Required
CCS certification Scheduling Requirements
Shift: 8:00am – 4:30pm, Monday‑Friday Full Time Remote Essential Functions
Ensures the accuracy and integrity of ICD-10-CM/PCS, CPT coding when applicable and DRG assignment for adherence to Federal and State Regulations and Compliance Guidelines Critically analyzes each Medicare inpatient medical record to apply appropriate coding, DRG judgments, SOI, ROM and POA Independently manages SMART pending queues for all acute care RWJBarnabas facilities, reviewing ICD-10-CM/PCS coding and DRG assignment of medical records flagged by SMART Independently manages EPIC SMART WQ’s to assure proper workflow of identified accounts Directs coders with appropriate case‑specific recommendations. Educates and coaches coders in the application of coding principles, code assignment and sequencing, DRG assignment and clinical disease processes Sustains an excellent organizational average accuracy rate by leveraging advanced knowledge of coding practices The Quality Officer's coding analysis is reviewed by the Coding Specialists biannually; incorrect judgments affecting the DRG may result in increased monitoring until quality scores of 90% or better for two consecutive months are obtained Productivity Standards must be met for all Quality Officers; failure to meet standards will result in progressive disciplinary action Provides guidance to Quality Officer 1 and 2 as requested Independently monitors SMART queues to ensure all records imported by SMART are reviewed and properly directed, released to billing as appropriate and within department timelines Works as a team with other Quality Officers to ensure SMART review goals are met for all RWJBarnabas facilities May review ICD‑10‑CM/PCS coding associated with RAC audits and/or other additional medical records as needed, providing appropriate written feedback including rationale, research, and coding guidelines to management and/or the Coding Specialists Reviews Discharge Status, Admission and Discharge Dates, and other related demographic information coded and entered by affiliate staff for accuracy and completeness, communicating need for Case Management review when appropriate Reviews Present on Admission (POA) indicators for all diagnosis coded and entered by coders for accuracy and completeness Reviews Physician Queries submitted by staff for necessity, accuracy and completeness and communicates recommendations to sites as appropriate Participates in the review of other payers as directed Independently reports problems with any and all computer system to RWJBarnabas IT&S or SMART helpdesk for resolution May perform classroom training in ICD‑10‑CM/PCS and CPT coding for affiliate staff when needed at the internal RWJ Barnabas Coding School that may be held to train new facility coders Maintains proper computer and written records of all review activity Effectively communicates coding recommendations and rationale to Coding team Performs regulatory coding research as needed Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. Benefits and Perks
Paid Time Off including Vacation, Holidays, and Sick Time Retirement Plans Medical and Prescription Drug Insurance Dental and Vision Insurance Disability and Life Insurance Paid Parental Leave Tuition Reimbursement Student Loan Planning Support Flexible Spending Accounts Wellness Programs Voluntary Benefits (e.g., Pet Insurance) Community and Volunteer Opportunities Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon …and more! Choosing RWJBarnabas Health!
RWJBarnabas Health is the premier health care destination providing patient-centered, high-quality academic medicine in a compassionate and equitable manner, while delivering a best-in-class work experience to every member of the team. We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time. As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health. RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey—whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education. Equal Opportunity Employer
RWJBarnabas Health is an Equal Opportunity Employer.
#J-18808-Ljbffr