Quality Assurance Officers

Inpatient Coding Quality Officer III - (Medicare) Barnabas Health Corp Department: HIM - Coding Quality Status: Full-Time Shift: Day The above reflects the anticipated annual salary range for this position if hired to work in New Jersey. The Quality Officer 3 is responsible for ensuring accuracy and integrity of ICD-10-CM/PCS coding and DRG assignment for inpatient Medicare encounters. This requires critical thinking and a higher level skill set due to the complexity and risk relative to Medicare patients. Quality Officer 3 must also sustain an excellent organizational average accuracy rate. Adherance 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.  Bachelor’s degree or equivalent in experience. ~5+ years acute care coding and/or auditing experience with a concentration on inpatient Medicare records is required with a Bachelor’s degree. ~9+ years acute coding and/or auditing experience required without 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 is required. Knowledge of Medicare and Medicaid billing and coding regulations. Must be capable of critical thinking and analysis and written conveyance of same. Must be able to work independently and cooperatively with minimal supervision. Must foster positive relationships with fellow co-workers and the coding team. ICD-I0-CM/PCS proficiency required. Position is primarily remote 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 judgements, SOI, ROM and POA. Independently manages SMART pending queues for all acute care RWJBarnabas facilities. Reviews ICD-10-CM/PCS coding and DRG assignment of medical records as “flagged” by SMART. Independently manages EPIC SMART WQ’s to assure proper workflow of identified accounts. Educates and coaches coders in the application of coding principles, code assignment and sequencing, DRG assignment and clinical disease processes. Coding advice must be clearly and concisely written with appropriate clinical indicators cited. Additional facilities that may join the System receive the same education and coaching from the Quality Officers to ensure a unified methodology within the RWJBH organization. This results in improved outcomes in DRG assignment, coder education and DNB lag time within all facilities. Sustains an excellent organizational average accuracy rate by leveraging advanced knowledge of coding practices leading to exceptional results. The Quality Officer’s coding analysis is reviewed by the Coding Specialists on a biannual basis. The consequences of incorrect judgments affecting the DRG may include an increased monitoring, until quality scores of 90% or better for two consecutive months are obtained. The consequences of incorrect coding resulting in erroneous DRGs includes under reporting and/or over reporting. Incorrect coding may result in an incorrect reporting of diagnoses and procedures to the patient’s EHR which may affect the patient’s future care, insurance claims and coverage. When accounts are not reviewed and released in a timely manner, there is a detrimental impact to the reimbursement flow for the facility (DNB). Productivity Standards must be met for all Quality Officers. 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, with/or without coding or other recommendations, or released to billing as appropriate and within department accepted 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, and provides appropriate written feedback including rationale, research, and coding guidelines to management and/or the Coding Specialists. Communicates the need for Case Management review to the RWJBarnabas facilities when appropriate. Reviews Physician Queries submitted by staff for necessity, accuracy and completeness and communicate recommendations to the sites as appropriate. 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 which 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. At RWJBarnabas Health, our market-competitive Total Rewards package provides comprehensive benefits and resources to support our employees’ physical, emotional, social, and financial health. Medical and Prescription Drug Insurance Dental and Vision Insurance Retirement Plans Short & Long Term Disability Life & Accidental Death Insurance Tuition Reimbursement Health Care/Dependent Care Flexible Spending Accounts 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.

Created: 2025-10-03