Overview
Associate II, Quality Assurance Engineering Jobs in Irvine, CA at Alcon
Description:
POSITION SUMMARY:
The Quality Assurance (QA) Specialist is responsible for performance of internal coding QA reviews. These reviews provide an additional layer of internal coding quality and compliance of inpatient (IP) records to assure appropriateness and accuracy of code assignments in accordance with official coding guidelines and client facility specific coding guidelines.
PRIMARY JOB RESPONSIBILITIES:
Performs IP coding quality assurance (QA) reviews
Maintains turnaround time expectations to minimize impact to client DNFB
Maintains an up-to-date working knowledge of MS-DRG, APR-DRG, ICD-10 CM/PCS coding
Identifies, applies, and validates the use of current industry standard clinical indicators, risk factors and treatment protocols/order sets used in clinical validation of payment impacting code assignment
Abstracts and performs a comprehensive review of the medical record to assess the documentation present/absent as it compares to the base code set impacting payment, or a requested change in coding
Review scope includes validation of the MS-DRGs and APR-DRGs assigned for Medicare, Medicaid, commercial, and third-party claims
Recognizes when a documentation clarification or confirmation query is necessary
Writes a query ask with clinical indicators and/or documentation excerpts if a discrepancy or gap exists in the medical record documentation and the (base, desired) code assignment per application of Official Coding Guidelines, or if a medical condition does not appear to be clinically supported or meeting clinical criteria requirements
Query request writing ability requires knowledge of different types of queries and compliant query practices including knowledge and application of clinical validation criteria
Develops and maintains a strong understanding of Accuity and of client specific technology, policy, procedures, guidelines, and workflows
Ensures strict confidentiality of patient information
Accountable for meeting or exceeding both production and quality expectations
Meets or exceeds short-term and long-term goals as established for the department
May require schedule flexibility and change to accommodate workflow and client business needs
Participates in staff meetings and attends other meetings and seminars as required
Performs miscellaneous job-related duties as assigned
Requirements:
POSITION QUALIFICATIONS:
Education:
High School Diploma or GED required
Associate’s degree in health information management or similar preferred
Licensure and/or Credentials/Certifications:
Health information management and/or coding credential from AHIMA and/or AAPC required (RHIA, RHIT, CCS, CPC, and/or CIC)
CCDS or CDIP certification preferred
AHIMA ICD-10/PCS trainer certification preferred
Experience:
Minimum 5 years of hospital inpatient coding experience required
Minimum 2 years inpatient/DRG auditing experience required
Minimum 2 years inpatient clinical documentation improvement experience preferred
Experience with electronic health records and health information systems as well as different encoders
Experience and knowledge in DRG reimbursement (i.e., MS-DRG, APR-DRG)
Demonstrated knowledge of all applicable coding clinics as they relate to current IP coding practices
Knowledge, Skills, and Abilities:
Expert knowledge of Official Coding Guidelines, advanced knowledge of APR and MS DRG reimbursement models, state, and federal regulations
ICD-10-CM/PCS coding expertise including POA assignment and discharge disposition codes
Knowledge of AHRQ Quality Metrics including patient safety indicators (PSIs), Hospital Acquired Conditions (HACs), Vizient Mortality Models, CMS Core Measures, other national patient safety quality indicators, and different payor categories
Knowledge of quality assurance/healthcare internal auditing concepts and principles
Solid command of anatomy, physiology, pathology, laboratory, imaging, pharmacology, disease assessment, patient management, and treatment
Knowledge of legal, regulatory, and policy compliance issues related to medical coding and documentation
Knowledge of current and developing issues and trends in medical coding diagnosis and procedure code assignment
Advanced knowledge of medical coding, electronic medical record systems, and coding systems
Ability to use independent judgment and to manage confidential information
Ability to analyze and problem solve
Detail oriented with ability to multi-task
Strong communication (written and oral) and interpersonal skills
Ability to clearly communicate information to coders, physicians, and CDI staff
Ability to provide guidance and training to Accuity coding, physician, and CDI staff
Independent, focused individual who takes initiative and can work remotely
Able to execute under the pressure of time constraints and maintain focus over period of work hours
Demonstrates ability to work independently as well as cooperatively with various teams
Serves as a professional role model for internal and external customers
Certifications and/or professional license must be maintained as a condition of employment
Maintains subject matter expertise in clinical validation criteria and practices, ICD-10-CM/PCS code sets, coding guidelines, clinical documentation integrity, and inpatient payment methodologies as a condition of employment
Ability to use a PC in a Windows environment, including MS Office applications
Independent, focused individual able to work remotely or on-site
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Title: Associate II, Quality Assurance Engineering
Company: Alcon
Location: Irvine, CA
