Inpatient (IP) Global QA Coder Auditor

R1 RCM PHILIPPINES, INC. is seeking an experienced Multi-Specialty Quality Reviewer to join our Cebu team. This is a full-time position where you will be responsible for conducting internal quality reviews across different medical coding specialties to assess coder performance and coding accuracy.

Responsibilities

• Conduct audits in various medical coding specialties in inpatient settings to assess coding accuracy and ensure adherence to official coding guidelines.
• Provide detailed rationale and supporting references for recommendations and findings.
• Utilize industry-recognized references to support review findings, such as the ICD10-CM Official Guidelines for Coding and Reporting, ICD-10-PCS Official Guidelines for Coding and Reporting, AHIMA Standards of Ethical Coding, AHIMA Practice Briefs related to compliant querying, and AHA Coding Clinic.
• Identify coding error trends across multiple specialties to aid in root cause analysis.
  • Stay current with updates in medical coding guidelines, payer-specific requirements, and client-specific requirements.
• Prepare and present reports summarizing audit findings and error trends.
• Identify smart observations for process improvements with quantifiable business impact.
• Calibration sessions between Operations, Quality, and Training to ensure knowledge alignment with client needs and specifications.
• Calibration sessions between processes such as Back-end and Middle Coding.
• Adhere to HIPAA regulations and uphold a high standard of privacy and confidentiality.
• Adhere to all policies and procedures to ensure an efficient workflow process.
• Researching, escalating, and responding to auditor support questions as triaged by leadership.
• Other duties as assigned by leadership (special projects, assessments, etc.).

Required Qualifications

• Bachelor's degree in a medical allied course is preferred. For other courses, a high level of knowledge and relevant work experience to illustrate capability.
• More than 2 years in the associate position (e.g., Medical Coding / Billing Review).
• At least 5 years of total work experience in medical coding for inpatient settings with exposure to multiple specialties.
• At least 1 year of experience in coding transplant cases.
• License/Certifications: Currently holds and maintains at least 1 role-related certification (RHIA, RHIT, CCS, CIC for inpatient roles).
• Strong knowledge of CMS guidelines, and Inpatient Prospective Payment System (IPPS).
• Experience working with coding software such as Epic, Cerner, Meditech, and 3M 360.

Good to have Qualifications

• Additional certifications in specific specialties (CPC, COC, CCS-P, CEMC, CASCC, CEDC, CGSC, CHONC, CIRCC, COBGC for specialty roles, CPMA for auditing role) are a plus.
• Experience in professional and facility outpatient coding is a plus.
• At least 1 year of experience as a quality auditor is preferred.
• Excellent communication skills, presentation skills, and proficiency in MS Excel & PowerPoint.
• Proficiency in medical terminologies and disease processes.

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