RCS Quality Expert CC

Quality Management Team Member

This position exists to support Revenue Cycle Services' Total Quality Management team. This position will be responsible for performing various quality reviews, preparing and providing feedback to operational team members as well as other departments, and assisting in the development of Standard Work for team members. This position will help to ensure the accuracy and completeness of clinical medical record documentation and clinical coding as it pertains to assignment of patient status, documentation of care provided, support of billing for services provided and affect that data has on hospital reporting. This position will also be very involved in various quality initiatives across the Indiana University Health system.

Key responsibilities/duties of this role

• Performance of provider or coder quality reviews to ensure compliance with ICD-10 diagnosis coding, CPT coding including modifiers, CCI edits, other payer edits, Medicare and commercial payer policies as well as any regulatory coding guidelines across all specialties.
• Attending and providing education to physicians, APPs, coders, other leaders around results of reviews, coding, payer guidelines, etc as needed.
• Assist with any coding questions, research, etc as needed.

Must Haves

• Current coding or health information credential through AHIMA or AAPC.
• 3-5 years of coding and/or quality review experience with a preference of multispecialty coding of both surgical procedures as well as E/M coding.
• Knowledge of revenue cycle requirements and regulations with a preference of understanding both coding and billing, but the later is not a requirement.
• Requires critical thinking, problem solving, working well with others and strong presentation skills.
• Requires effective written and verbal communication skills in both individual and group settings.

Other Requirements

• Requires RHIA, RHIT, CCS, CCS-P, CPC, CIC, or COC, or an active Registered Nurse (RN) license in the state of Indiana or an active Nurse Licensure Compact (NLC) RN license., ASN required, BSN preferred (based on position/focus).
• Requires High School Diploma.
• Associate or Bachelor Degree in Health Information Management, Coding, Nursing or Finance is preferred.
• Six Sigma or Lean Six Sigma training preferred.
• Requires 5+ years? experience in revenue cycle operations in various positions related to utilization management, coding, billing, collections, payment adjustments, auditing, denial management and medical record completion.
• Requires ability to read, understand and interpret medical records and other treatment documentation.
• Requires a high level of interpersonal, problem solving, and analytic skills.
• Requires effective written and verbal communication skills in both individual and group settings to ensure professional correspondence and presentation to all levels of individuals within the organization (operational team members, leadership? internal and external to Revenue Cycle, clinicians, physicians, auditors and other external individuals/groups).
• Requires the ability to establish and maintain collaborative working relationships with others.
• Requires ability to set and adjust defined priorities as necessary and to process multiple tasks at once.
• Requires strong attention to detail, problem solving and critical thinking skills.
• Requires ability to work with and maintain confidential information.
• Requires proficiency in the use of Microsoft Office applications (Word, Excel, PowerPoint, OneNote, Visio & Access).

Indiana University Health