The Quality Officer III ensures accuracy and integrity of ICD-10-CM/PCS coding and DRG assignment for inpatient Medicare encounters. This senior role requires critical thinking due to the complexity and risk related to Medicare patients and maintaining an excellent organizational average accuracy rate. Responsibilities include adherence to Federal and State Regulations, Compliance Guidelines, and coding standards set by RWJBarnabas Health, AHA, and AMA.
Duties involve critical analysis of Medicare inpatient records for appropriate coding and DRG assignment, managing SMART pending queues across facilities, reviewing coding flagged by SMART, directing and educating coders on coding principles, ensuring unified methodology across facilities, and sustaining high accuracy rates. The officer also reviews coding related to RAC audits, maintains coding documentation, communicates coding recommendations, performs coding research, and may provide classroom training.
The position requires independent work with minimal supervision, excellent communication, organizational skills, and a professional demeanor. It may involve additional duties as assigned.
Benefits include paid time off, medical/prescription drug insurance, dental/vision insurance, retirement plans, disability insurance, life insurance, tuition reimbursement, flexible spending accounts, wellness programs, and employee discounts.
- HS diploma or GED equivalent
- Bachelor's degree or equivalent working experience
- 5+ years acute care coding/auditing experience focusing on inpatient Medicare records with a Bachelor's degree
- 9+ years acute coding/auditing experience without a Bachelor's degree
- Certified Coding Specialist (CCS) required; proficiency with ICD-10-CM/PCS
- Extensive knowledge of ICD-10-CM/PCS, CPT coding, medical terminology, anatomy, physiology, clinical indicators, and pharmacology
- Knowledge of Medicare and Medicaid billing and coding regulations
Preferred qualifications:
- Bachelor's Degree
- CPC-H, RHIT, RHIA, and/or RN certification preferred
- Paid Time Off (PTO)
- Medical and Prescription Drug Insurance
- Dental and Vision Insurance
- Retirement Plans
- Short & Long Term Disability
- Life & Accidental Death Insurance
- Tuition Reimbursement
- Health Care/Dependent Care Flexible Spending Accounts
- Wellness Programs
- Voluntary Benefits (e.g., Pet Insurance)
- Employee Discounts through partners such as NJ Devils, NJ PAC, Verizon, and more
Location
New Jersey, US
Employment Type
Full-time
Experience Level
Senior
Salary Range
$83,156 - $117,458
Remote work allowed
Yes
Posted
1 month ago