Quality Analyst - Facility IP

Overview

Quality Analyst (Facility IP) role at Guidehouse India in Chennai, focused on planning, monitoring and evaluating coding quality assurance production and reviewing inpatient coding and reimbursement accuracy.

What you'll do

• Plan, monitor, direct and evaluate QA production on a daily basis and ensure daily schedules are met.
• Communicate with the Director of Coding Operations when situations occur that hinder meeting deadlines, and implement measures to return to established schedules as early as possible.
• Ensure QA communicates a valid, workable schedule for each client each week.
• Review medical record documentation for accuracy in code assignment of primary/secondary diagnoses and procedures using ICD-9-CM and CPT-4 coding conventions.
• Sequence diagnoses and procedures using coding guidelines and ensure MS-DRG/APC assignment is accurate where applicable.
• Abstract and compile data from medical records for optimal/compliant reimbursement for hospital and/or professional charges.
• Review code assignments that are not straightforward or where documentation is inadequate, ambiguous or unclear.
• Answer quality staff queries on a day-to-day basis and escalate to the Director of Coding as necessary.
• Meet agreed sampling targets and accuracy.
• Keep abreast of coding guidelines and reimbursement reporting requirements.
• Document QA data and record findings in the QA system (Guide Audit) for client reporting, risk identification, training development and standardization.
• Guide and mentor coders.
• Help ensure continuing education is planned, scheduled and completed for all coding/QA teams.
• Coordinate scheduled quality meetings with QA and production staff.
• Bring identified concerns to Guidehouse's coding compliance management.
• Take active part in project launch sessions with team leaders and rotate across teams as assigned.
• Abide by the AHIMA Standards of Ethical Coding and official coding guidelines.
• Maintain understanding of anatomy and physiology, medical terminology, disease processes and surgical techniques.
• Assist with research, development and presentation of continuing education programs and with special projects such as focused audits and client launches.
• Understand and abide by the organization's information security policy and report security incidents to the appropriate authorities.

What you'll need

• Key skill: IP DRG auditing.
• 5+ years of experience.
• Accredited medical coder (CCA, CCS, CPC or CPC-H) with at least 3+ years' experience.

Nice to have

• Experience with Microsoft Excel, Word and PowerPoint.

Details

• Location: Chennai, India.
• Travel: None required.
• Clearance: None required.