- Plans, monitors, direct and evaluate QA production on a daily basis. Ensures that daily schedules are met and communicates with Director, and Associates Operations if situations occur that hinder meeting deadlines. If system issues or other emergencies delay QA, implements measures/schedules to return to established schedules at the earliest possible time. This should be done closely with each quality specialist to ensure the needs are met and that satisfy our client requirements.
- Responsible for ensuring that the QA communicates a valid, workable schedule for his or her client each week. Accurate, sensible & on-time.
- **If this doesn t happen properly, it s the responsibility of the Lead Specialist to make it happen promptly.
- Review medical record documentation for accuracy in code assignment of the primary/secondary diagnosis and procedures using ICD-9-CM and CPT-4 and latest Associates conventions. Sequence the diagnosis and procedures using Associates guidelines. When applicable, ensure MS-DRG/APC assignment is accurate. Abstract and compile data from medical records for appropriate optimal/complaint reimbursement for hospital and/or professional charges. This involves reviewing code assignments that are not straightforward or the documentation in the record is inadequate, ambiguous, or unclear for Associates purposes.
- Answers queries from the quality staff on a day to day basis and escalating to the Director of Associates as necessary.
- Meets agreed sampling targets and accuracy.
- Keeps abreast of Associates guidelines and reimbursement reporting requirements.
- Documents QA data on teams of QA/Associates and records findings in the QA system (RevAudit), which will be for reporting to the client, identifying risk areas, development of training and education programs and development/implementation of standardization within the organization. This also involves guidance and mentorship of Associates.
- Helps to ensure that continuing education is planned, scheduled and completed for all Associates/QA teams through the coordination Coordinates scheduled quality meetings with the QA and production staff.
- Brings identified concerns to Navigant Associates compliance management for discussion.
- Project Launch - Active involvement in project launch sessions along with team leaders to understand the Associates process.
- Have a rotational arrangement and is flexible to work with any given team as assigned.
- Abides by the Standards of Ethical Associates as set forth by the American Health Information Management Association and adheres to official Associates guidelines. -
- Maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes and surgical techniques to effectively apply ICD-9-CM and CPT-4 Associates guidelines to inpatient and outpatient diagnoses and procedures.
- Assist with research and development and presentation of continuing education programs on areas of specialization.
- Assist with special projects as required. Example: Focused audits; client launches, etc.
What You Will Need :
Graduates in any discipline
1 - 3 Years experience
- Individual should have ability to provide solutions commensurate with the client s needs within the ambit of the given environment so as to lead to business results. 2. Meet the defined Quality Scores as defined by the process. 3. To consistently meet or exceed CSAT parameters as defined for the process.
