Coding Quality Review Specialist

General Summary of PositionPerforms coding quality reviews on medical records Primary Duties and Responsibilities Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations.Assists with the development of system-specific coding guidelines as needed, and participates in Quality review team meetings.Having knowledge of coding compliance plan, directs efforts to achieving plan by focusing on areas identified through coding reviews or targeted by management for improvement.Helps select areas for focused quality reviews.Maintains continuing education. Maintains credentials, for required job classification.Meets established Quality, Accuracy, and Productivity standards as defined by policies.Provides/identifies trends to provide feedback to appropriate sources. Identifies and assists in areas to provide additional training/education, under the direction of Manager.Responsible for retrospective and concurrent reviews on coding staff.Reviews, analyzes, and interprets medical record documentation to identify diagnoses and procedures. Assigns correct ICD and/or CPT diagnostic and procedural codes using standard guidelines and automated encoding software. Assigns the appropriate DRG.Works closely with the Coding Quality Review team and outpatient coding staff to identify areas for improvement and problematic cases.Participates in multi-disciplinary quality and service improvement teams   Minimum Qualifications EducationHigh School Diploma or GED required ; Bachelor's degree with successful completion of medical terminology, anatomy, physiology, and coding courses in ICD-10-CM and CPT-4 preferred Experience2 years inpatient coding experience, preferably in an acute care setting required; 1-2 years Auditing experience preferred Licenses and CertificationsCCS (Certified Coding Specialist) through AHIMA required Certification as a Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) preferred Knowledge, Skills, and AbilitiesExcellent verbal and written communication skills.Excellent interpersonal skills, Good public speaker and presenter.Basic computer skills preferred. This position has a hiring range of $30.67 - $54.48  

Created: 2025-10-02