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The Concurrent Quality Reviewer of our hospital reviews documentation in the electronic medical record (EMR) and ensures that accurate assignment and sequencing of ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes in accordance with national coding guidelines. The primary focus of this role is to capture all encounter-specific diagnoses, procedures, and documented conditions for accurate reporting and research purposes. The goal is to achieve concurrent/real time assignment of ICD-10 codes and DRGs. This will be achieved by optimizing accuracy of documentation by collaborating with the providers, CDIs, Coders, Quality, and other relevant multidisciplinary teams. The concurrent inpatient quality reviewer will assign a working DRG, as well as capture and ensure accurate POA assignment, severity of illness, mortality risks, SDOH codes, etc. This position will assist with identifying trends that will be used to develop and provide educational training for CDI teams, providers, etc.
Uphold compliance by assigning and sequencing accurate ICD 10 codes to inpatient medical records as per guidelines, demonstrating behavior that reflects integrity, shows a commitment to ethical and legal coding practices, and fosters trust in professional activities.
Determines and assigns the principal diagnosis and all significant secondary ICD-10-CM diagnoses as well as Present on Admission (POA) indicator and ICD-10-PCS procedure codes, using official coding guidelines
Validates the accuracy of codes assigned by the computer assisted coding software, recognizing inappropriate application of clinical coding regulations/guidelines, and revising the codes assigned based on expert subject matter knowledge and provider documentation.
Literacy and proficiency in computer technology, particularly related to health information and coding applications utilized for daily job performance, are essential.
Strong ability to analyze clinical documentation to ensure codes reported are clearly and consistently supported by the health record.
Examine and ensure that the MS-DRG, APR-DRG, SOI, and ROM of each inpatient encounter is compatible and compliantly optimized. Familiarity with CCs, MCCs, Elixhauser, and other specialty specific conditions that impact USNWR is given priority.
Request clarification from the provider when there is conflicting, incomplete, or incorrect information in the health record regarding a significant reportable condition or procedure or other reportable data element collaborating with the Clinical Documentation Specialists for concurrent queries to the providers, ensuring physician responses to queries are reflected in the code assignment.
Abstract relevant information accurately and completely into the computer assisted coding application, including but not limited to present on admission (POA) indicators.
Verify and revise according to documentation in the medical record the correct discharge disposition of encounters coded.
Confirm the admission status ordered by the physician in the medical record documentation and the registration status of the encounter are compatible with orders.
Communicates professionally identified discrepancies, documentation issues, denial management issues and coding concerns in the medical record to the appropriate department and/or leader.
Stays up to date with regulatory changes by completing all mandatory educational accountabilities in a timely manner.
Maintain coding quality and productivity as per departmental standards.
Attends department meetings and other inpatient conferences and seminars as scheduled.
Maintain and observe patient confidentiality as outlined in the National Patient Safety Goals and HIPAA guidelines always protecting the confidentiality of the health record and refraining from accessing protected health information not required for coding-related activities.
Maintains coding accuracy and productivity standards of ≥ 95%.
Attends educational meetings and seminars to maintain certification and continuing education requirements.
Prepare ad-hoc reports as requested by senior management.
Develops, mentors, educate and provide feedback to providers, CDI, and others as applicable in coding and ICD-10/DRG code assignment.
Adheres to University and unit-level policies and procedures and safeguards University assets.
This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.
MINIMUM QUALIFICATIONS
Education:
Bachelor's degree in a related field such as Business Administration, Health Care Administration, Health Information Management is required.
Certification and Licensing:
Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), and/or Certified Inpatient Coder (CIC) highly desired.
Experience:
Minimum 5 years of coding in an inpatient hospital setting.
Must have ICD-10-CM/PCS medical coding experience.
Strong knowledge of anatomy and physiology, medical terminology, and disease processes.
Advanced technical skills for use of MS Office (Excel, Word, Outlook, and PowerPoint). Experience with CAC must.
Knowledge, Skills, and Aptitudes:
Skill in completing assignments accurately and with attention to detail.
Ability to analyze, organize, and prioritize workload while consistently meeting ≥ 95% productivity and accuracy standards.
Understanding of and adherence to the Health Insurance Portability and Accountability Act (HIPAA).
Commitment to the University of Miami Health System policies and procedures.
Must stay up to date with continuing education requirements to maintain credentials.
Ability to work independently and/or in a collaborative environment.
Strong background in use of encoder, computer assisted coding, and EMR software applications.
Efficient communication skills - interpersonal, verbal, and written.
Strong organizational and analytical skills.
Critical thinking skills and ability to interpret, assess, and evaluate provider documentation.
Proficient with Microsoft Office applications.
Ability to sit for long periods of time.
Capable of working in a 100% remote environment with little supervision, while also staying focused on assigned tasks.
The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.
UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for.
The University of Miami is an Equal Opportunity Employer - Females/Minorities/Protected Veterans/Individuals with Disabilities are encouraged to apply. Applicants and employees are protected from discrimination based on certain categories protected by Federal law. Click here for additional information.
