QA I Coding Operations

Overview

The QA I, Clinical Ops position works with the Coding & Clinical Validation Audit team focused on risk coding. The QA position monitors & reports on the accuracy of all code captures on a % of all images of their assigned coders. This position also answers all questions for their coders through the Questions Queue or via email. QA is also responsible for assisting in the remediation for their coders which include full image review of all images coded prior to release to ensure accuracy of image, for any coder below project benchmark.

Responsibilities

The QA I, Clinical Ops position works with the Coding & Clinical Validation Audit team focused on risk coding. The QA position monitors & reports on the accuracy of all code captures on a % of all images of their assigned coders. This position also answers all questions for their coders through the Questions Queue or via email. QA is also responsible for assisting in the remediation for their coders which include full image review of all images coded prior to release to ensure accuracy of image, for any coder below project benchmark.

• Provides Quality Assurance feedback by working as a liaison between Coder I, Coder II and the Team Lead to ensure 95% coding accuracy. Reviews a defined percentage of the Coder I and Coder II work to ensure a 95% accuracy rate is maintained. This is for new hires as well as existing staff.
  • 100% of the work is reviewed for a new Hire until they have a consistent 95% accuracy rate.
  • No more than 10% of the work is reviewed for Coder I, Coder II once they have tested at 95% quality.
• Completes image review for proper HCC mapped diagnosis coding from various chart types (physician, Facility, non – Facility). Ensures that the highest level of HCC mapped diagnosis code was utilized in each date of service reviewed and documentation of findings in company data storage program. Professionally communicates finds, errors, and any suggestions to all staff in order to facilitate on-going communications and efficient department operations.
• Completes internal audits as necessary to support quality accuracy.
• Responds to questions via the ‘Questions Queue’ for individual coders.
• Reviews internal system reports on quality of work for all assigned Clinical Coder Specialists. These reports are reviewed daily, weekly, monthly, quarterly and yearly …