Job Snapshot
Location:
Norwalk, CT 06855
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Industry:
Healthcare - Health Services
Managed Care
Job Type:
Health Care
Insurance
Experience:
At least 3 year(s)
Contact Information
Description
PRINCIPLE PURPOSE OF JOB: The Quality Assurance Analyst
is responsible for auditing the internal and external inpatient DRG audit staff. The QA Analyst samples auditor’s monthly audit output from the point of audit assignment through CAT confirmation and any subsequent appeals that are received. Quality assurance findings are logged, documented and findings reported back to management and audit staff. Strong attention to detail and analysis skills are required as well excellent written and verbal communication skills. Extensive knowledge of ICD-9-CM, DRGs, medical terminology and inpatient hospital claims processing is required.
PLEASE NOTE: This position is located in Norwalk, CT. No relocation assistance is available for this position. Healthcare industry experience is required.
ESSENTIAL JOB RESPONSIBILITIES:
Primary Responsibilities
Auditing & Documentation – ensure ongoing quality and consistency is provided by the internal and external audit team
- Perform monthly coding quality assurance audits for all audit / appeals staff in accordance with defined company policies and procedures
- Identifies coding and DRG deficiencies by auditor based on random or targeted samples
- Provides educational instruction to audit staff regarding identified coding / DRG discrepancies on an ongoing basis; acts as a coding resource to audit staff
- Documents audit results and maintain log / tracking tools timely
- Provide feedback to the management personnel regarding audit results
- Compile monthly, or more frequent if requested, audit results / summaries for management
- Monitor monthly statistical reports to identify trends and / or potential coding training issues
- Categorizes discrepancies by root cause and calculates appeals and accuracy rates by auditor and non-auditor error and incorporates into reporting
- Obtains feedback from physician and appeals auditors, Medical Policy business units and Client Services and incorporates into reporting
- Auditing of other departments may be assigned (Provider Relations & Mailroom Services)
Training – assist in the development and distribution of internal training materials related to the quality assurance process and guidelines. Ensure new auditors are familiar with the quality assurance process and communicate results / findings of audits from start date through their orientation period.
- Assists with testing and initial training of new auditors
- Identifies auditor talent areas and provides feedback to management for work assignment purposes
- Assists with corrective action and/or increased quality assurance activities on audit staff falling below required expectations
Other Related Responsibilities
- Delivers personal assignments dependably, reliably, and on-time through organized personal work processes.
- Exhibits behaviors consistent with iHT Values.
1. Integrity
2. Our Clients
3. Our Team
4. Accountability
5. Performance Excellence
6. Continuous Improvement
Requirements
- Relevant medical coding certification; CCS through AHIMA preferred or CPC-H though AAPC
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Minimum of three years inpatient DRG coding experience
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Minimum of three years coding auditing experience
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Minimum of three years quality assurance experience
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Knowledge of medical record practices, state and federal laws relating to release of medical information, ICD-9-CM and CPT coding systems, medical terminology to understand diagnoses and procedures, and the content and organization of a medical record
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Prior formal training or working understanding of basic medical terminology as well as anatomy and physiology
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Strong knowledge and capability for process improvement, process management, and measurement
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Demonstrated experience and capability of organizational skills, sound judgment and decision making, and results focus
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Strong listening, written and oral communication skills
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Highly organized and able to manage and prioritize many tasks
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Strong Microsoft Office skills (Word, PowerPoint, Excel)
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Strong focus on detail, root-cause analysis, and change management
JOB DEMANDS:
- Very rare requirement to travel
- Work from iHT office majority of time
- Ability to work seated at a computer for long periods of time
- Occasional after hours and/or weekend availability required when necessary for auditor support or imposed deadlines
HOW TO APPLY:
We are currently growing with tremendous opportunities for individuals who want be a part of an extremely fast growing, dynamic and successful company who values and rewards its employees. To apply for this position, please send your resume along with your cover letter stating your salary history for your two most recent jobs to [Click Here to Email Your Resumé].
You may also review and apply for our additional current openings at http://www.ihealthtechnologies.com/careers.html.
Due to the volume of responses we receive, we are unable to reply personally to each submittal. However, if you are selected to move forward in the process, someone will be in touch with you concerning next steps.
iHealth Technologies offers a comprehensive benefits package including medical and dental coverage, 401(k) Plan, Profit sharing, vacation, paid holidays
iHealth Technologies supports a diverse workforce and is an Equal Opportunity Employer, M/F/D/V
