RWJBarnabas Health · 2 weeks ago
HIM Coding Quality Officer III, Remote
United States
Full-time
Remote
Senior Level
$87K/yr - $123K/yr
5+ years expRWJBarnabas Health is the premier health care destination providing patient-centered, high-quality academic medicine. The Quality Officer III is responsible for ensuring accuracy and integrity of ICD-10-CM/PCS coding and DRG assignment for inpatient Medicare encounters, while adhering to applicable regulations and guidelines.
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 Medicare 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
Provides Guidance to Quality Officer 1 and 2 as requested
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
May review ICD-10-CM/PCS coding associated with RAC audits and/or other additional medical records as needed, and provides appropriate written feedback including rationale, research, and coding guidelines to management and/or the Coding Specialists
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
Reviews Physician Queries submitted by staff for necessity, accuracy and completeness and communicate recommendations to the sites as appropriate
Participates in the review of other payers as directed
Independently reports problems with any and all computer system to RWJBarnabas IT&S or SMART helpdesk for resolution
May perform classroom training in ICD-10-CM/PCS and CPT coding for affiliate staff when needed at the internal RWJ Barnabas Coding School which may be held to train new facility coders
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
Qualification
Required
Bachelor's degree and 5+ years experience within acute care coding and/or auditing with a concentration on inpatient Medicare records or 9+ years of experience within acute care coding and/or auditing with a concentration on inpatient Medicare records in lieu of 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
Knowledge of Medicare and Medicaid billing and coding regulations
Excellent interpersonal, oral and written communication skills
Excellent organizational and time management skills
Must be able to work independently and cooperatively with minimal supervision
CCS certification
Preferred
CPC-H, RHIT, RHIA and/or RN licensure
Benefits
Paid Time Off including Vacation, Holidays, and Sick Time
Retirement Plans
Medical and Prescription Drug Insurance
Dental and Vision Insurance
Disability and Life Insurance
Paid Parental Leave
Tuition Reimbursement
Student Loan Planning Support
Flexible Spending Accounts
Wellness Programs
Voluntary Benefits (e.g., Pet Insurance)
Community and Volunteer Opportunities
Discounts Through our Partners such as NJ Devils, NJ PAC, and Verizon
Paid Time Off (PTO)
Short & Long Term Disability
Life & Accidental Death Insurance
Health Care/Dependent Care Flexible Spending Accounts
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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