Quality Assurance Specialist

Summary

The Quality Assurance Specialist plays a crucial role in ensuring the accuracy and quality of coding processes within our organization. This position requires an individual with exceptional analytical skills, attention to detail, and strong communication abilities.

Key Responsibilities:

• Collaborate with internal staff to develop and implement improved coding capabilities, focusing on documentation, coding, and compliance.
• Assess and review the overall quality of coding on completed accounts, ensuring adherence to established workflows and ethical coding standards.
• Design and implement quality coding review programs, communicating findings and recommendations to coding management.
• Obtain statistics and information necessary to assess risk across all areas of coding.
• Lead, coach, and recognize team members, providing guidance and support to ensure objectives are met and company culture is maintained.
• Administer the Quality Assessment process to guarantee that all quality standards and targets are met.
• Manage daily operational processes to ensure quality, efficiency, and productivity standards are met.
• Act as a client contact for day-to-day operational issues and staff assignments, escalating concerns to Medical Coding Manager or General Manager when necessary.
• Review and analyze reports, records, and data to meet and exceed client and company objectives.
• Collaborate with workgroups to resolve issues impacting internal and external customers.
• Reward and discipline employees, address complaints, and resolve problems.
• Strive for continuous improvement and development within the team.
• Ensure employees follow schedules properly and maintain efficient, accurate work assignments.
• Handle complaints, questions, and queries as necessary.
• Document general reports on team member performance and targets, ensuring they exceed targets.
• Monitor systems to ensure optimal performance.
• Disseminate changes in guidelines and rules, monitor changes in laws, regulations, and policies affecting clinical documentation and reimbursement to assure compliance.
• Foster a teamwork environment and service excellence within the department.
• Participate in performance improvement activities.
• Assist in establishing, implementing, and maintaining a formalized review process to ensure compliance with contractual agreements regarding accuracy rates.
• Assist in creating, monitoring, and standardizing company policies and procedures to monitor data quality management plan success, review risk areas, investigate identified issues, report data analyses, and take appropriate steps to correct violations.
• Make recommendations to ensure the highest compliance rate with the quality management plan.
• Participate in conference calls and meetings to address performance and training recommendations and implement improvement suggestions.
• Assist in new hire training classes, transition periods, and refresher trainings as needed.
• Knowledge of, understanding of, and compliance with all company policies and procedures.
• Provide feedback to management concerning possible problems or areas of needed improvement.
• Use, protect, and disclose patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.

Qualifications:

• Graduate of any medical or allied medical course or has equivalent work experience.
• Hold AAPC and/or AHIMA certification. CPMA is an advantage.
• Proficient with E/M and CPT procedure coding.
• Minimum six months' experience with exceptional performance in chosen area of quality management Medical Coding – demonstrated HIPAA knowledge required.
• Ability to work in a team-fostered environment and have the willingness to adjust to changing job responsibilities, shifting schedules, new procedures, and unexpected workloads and stresses.
• Possess strong verbal, written communication, interpersonal skills, and analytical skills.
• Willingness and flexibility to work extended hours.
• Assertive self-starter who can work independently, yet function in a team environment.
• Ability to plan well and prioritize work and maintain calmness under pressure.
• An understanding and strict adherence to all HIPAA regulations.

Working Conditions:

• Work Set-Up: Work From Home
• Work Schedule: Dayshift
• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; sit; perform manual tasks; operate tools and other office equipment such as computers, computer peripherals, and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix is an equal opportunity employer and does not discriminate against any employee or applicant based on race, color, religion, sex, parental status, national origin, age, disability, genetic information, political affiliation, military service, veteran status, or other non-merit-based factors.