Job Description
The Coding Quality Auditor and Specialist reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards. The Coding Quality Auditor and Specialist is required to be the expert in the work related to clinical documentation and coding. This position works in tandem with the Clinical Documentation Team assuring quality metrics are held to the highest standard for NM Health System.
The Coding Quality Auditor and Specialist is responsible for assuring coding guidelines and regulations are not compromised during the decision-making process related to clinical documentation and the coding of this documentation. This position partners with Clinical Documentation Nurses, Physicians, and other licensed providers to improve the quality of documentation, assuring best quality performance and representation of care provided. In addition, the Coding Quality Auditor and Specialist collaborates with the CMOs to ensure the integrity of the Health Record is established through best practices in Clinical Documentation and Coding.
The Coding Quality Auditor and Specialist is responsible for maintaining quality work queues and quality reports, advanced and complex project work that includes, but is not limited to, Risk Adjustment, Mortality Review, Hospital Acquired Condition (HAC) and Patient Safety Indicator (PSI) Review, Quality Abstraction and Analysis, and/or special and non-traditional project work. Incumbents to this role have a mastery of advanced clinical documentation integrity and quality concepts, coupled with the ability to consistently identify root causes and deliver measurable results. Key to this role is the ability to lead and facilitate quality initiatives and external rankings initiatives while remaining compliant within the coding guidelines and regulations.
The Coding Quality Auditor and Specialist solves complex problems and adds new perspectives to existing solutions. The Coding Quality Auditor and Specialist applies advanced knowledge of the national quality agenda and clinical documentation integrity and coding compliance to advance problem analysis and creative process redesign for Northwestern Medicine.
Responsibilities:
- Collaborates with clinical documentation team in the review of inpatient accounts (with an emphasis on mortality reviews) identifying documentation improvement opportunities
- Assess DRG, PDx, secondary Dx, PCS, POA and all other components of documentation thatimpact quality metrics
- Consistently assures coding practices remain compliant with coding guidelines and regulations
- Continually identifies educational opportunities related to coding and documentation
- Expert educator to clinical teams and medical staff
- Identifies strategic plans that will result in a positive impact to the clinical dashboard
- Develops clinical relationships across the health system securing interdepartmental support necessary for successful implementation of education strategies assuring achievement of overall strategic targets
- Ability to multi-task a variety of audits
- Ability to analyze data and construct appropriate action plans
- Develops teaching tools to promote quality outcomes
- Is an active member of clinical and executive meetings as identified
- Advanced understanding of quality metrics for health system (Vizient, PSI, USNWR)
- Advanced understanding of clinical documentation and coding through the lens of local and national quality and ranking methodologies, including but not limited to, U.S News and World Report, Vizient, Leapfrog, the CMS Star Rating, and payer contracts and assists the Managers of ClinicalDocumentation and Coding in implementing key strategies to effect change.
- Partners with Coding, Clinical Documentation leadership and Medical Directors to coordinate,maintain, and execute advanced project work that includes but, is not limited to, Mortality Review,HAC/PSI Review, Quality Abstraction and Analysis, and/or special and non-traditional project work.
- Partners with NM departments that includes but is not limited to: IT; Analytics; and Innovation todesign and implement new and advanced workflow solutions.
- Partners with third-party consultants/partners to contribute to workflow and methodology build andrefine as necessary.
Qualifications
Required:
- RHIT or RHIA or CCS Certification
- Certified Clinical Documentation Specialist
- Bachelor Degree – Healthcare related
- (will consider candidate currently enrolled in Bachelorprogram)
- Five years of coding experience in area of expertise
- Clinical expertise and understanding achieved through prior experience working with clinicaldocumentation teams
- Strong personal computer skills (Word, Excel, PowerPoint, Visio)
- Excellent verbal, written, and presentation skills
- Demonstrates critical thinking skills
- Excellent interpersonal skills
- Planning and time management skills
- Educational/training experience
Preferred:
- Master’s Degree in related field or currently enrolled in Master’s program
Additional Information
Northwestern Medicine is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.
Benefits
We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits section to learn more.
