RWJBarnabas Health · 2 weeks ago
HIM Coding Quality Officer I, Remote
United States
Full-time
Remote
Mid, Senior Level
$76K/yr - $107K/yr
4+ years expRWJBarnabas Health is a premier health care destination providing patient-centered, high-quality academic medicine. The Quality Officer I is responsible for ensuring the accuracy and integrity of ICD-10-CM/PCS coding and DRG assignment for inpatient encounters, requiring critical thinking and advanced coding skills.
DiabetesHealth CareNeuroscienceOutpatient CareRehabilitation
Responsibilities
Ensures the accuracy and integrity of ICD-10-CM/PCS, CPT coding when applicable and DRG assignment for adherence to Federal and State Regulations and Compliance Guidelines
Critically analyzes each inpatient medical record to apply appropriate coding, DRG judgements, SOI, ROM and POA
Independently manages SMART pending queues for all acute care RWJBarnabas facilities. Reviews ICD-10-CM/PCS coding and DRG assignment of medical records as “flagged” by SMART
Independently manages EPIC SMART WQ’s to assure proper workflow of identified accounts
Directs coders with appropriate case-specific recommendations. Educates and coaches coders in the application of coding principles, code assignment and sequencing, DRG assignment and clinical disease processes. Coding advice must be clearly and concisely written with appropriate clinical indicators cited. Additional facilities that may join the System receive the same education and coaching from the Quality Officers to ensure a unified methodology within the RWJBH organization. This results in improved outcomes in DRG assignment, coder education and DNB lag time within all facilities
Sustains an excellent organizational average accuracy rate by leveraging advanced knowledge of coding practices leading to exceptional results
The Quality Officer’s coding analysis is reviewed by the Coding Specialists on a biannual basis. The consequences of incorrect judgments affecting the DRG may include an increased monitoring, until quality scores of 90% or better for two consecutive months are obtained. The consequences of incorrect coding resulting in erroneous DRGs includes under reporting and/or over reporting. Incorrect coding may result in an incorrect reporting of diagnoses and procedures to the patient’s EHR which may affect the patient’s future care, insurance claims and coverage. When accounts are not reviewed and released in a timely manner, there is a detrimental impact to the reimbursement flow for the facility (DNB)
Productivity Standards must be met for all Quality Officers. Failure to meet productivity standards will result in progressive disciplinary action
Independently monitors SMART queues to ensure all records imported by SMART are reviewed and properly directed, with/or without coding or other recommendations, or released to billing as appropriate and within department accepted timelines
Works as a team with other Quality Officers to ensure SMART review goals are met for all RWJBarnabas facilities
Reviews Discharge Status, Admission and Discharge Dates, and other related demographic information coded and entered by affiliate staff for accuracy and completeness. Communicates the need for Case Management review to the RWJBarnabas facilities when appropriate
Reviews Present on Admission (POA) indicators for all diagnosis coded and entered by coders for accuracy and completeness
Independently reports problems with any and all computer system to RWJBarnabas IT&S or SMART helpdesk for resolution
Maintains proper computer and written records of all review activity
Effectively communicates coding recommendations and rationale to Coding team
Performs regulatory coding research as needed
May be required to perform other related duties
Qualification
Required
CCS required
ICD-I0-CM/PCS proficiency required
Bachelor's degree or equivalent in experience
4+ years acute care coding and/or auditing experience with a Bachelor's degree
7+ years acute coding and/or auditing experience required without a Bachelor's degree
Extensive knowledge of ICD-10-CM/PCS and CPT coding, medical terminology, human anatomy and physiology, clinical indicators associated with disease processes and pharmacology is required
Knowledge of billing and coding regulations
Must have excellent interpersonal, oral, and written communication skills
Must be capable of critical thinking and analysis and written conveyance of same
Must have excellent organizational and time management skills
Must maintain a professional demeanor
Must be able to work independently and cooperatively with minimal supervision
Must foster positive relationships with fellow co-workers and the coding team
Preferred
CPC-H, RHIT, RHIA and/or RN also encouraged
Benefits
Paid Time Off (PTO)
Medical and Prescription Drug Insurance
Dental and Vision Insurance
Retirement Plans
Short & Long Term Disability
Life & Accidental Death Insurance
Tuition Reimbursement
Health Care/Dependent Care Flexible Spending Accounts
Wellness Programs
Voluntary Benefits (e.g., Pet Insurance)
Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon, and more!
Company
RWJBarnabas Health
RWJBarnabas Health is New Jersey’s largest and most comprehensive academic health system, caring for more than 5 million people annually.
10001+ employees
H1B Sponsorship
RWJBarnabas Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2023 (1)
2021 (1)
2020 (1)
Funding
Current Stage
Late StageTotal Funding
$0.23MKey Investors
New Jersey Food Security Initiative
2024-07-02Grant· $0.23M
Leadership Team
Anthony Cava
President and CEO
Jordan Ruch
Chief Technology Officer
Recent News
2025-04-29
2025-04-14
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