Remote Coding Quality Reviewer

  • Cymetrix
  • United States
  • Apr 19, 2019

Job Description

The Coding Quality Reviewer shall report directly to the Internal Quality Control Coding Director and will be responsible for accessing and reviewing the medical record documentation, coding and abstracting accuracy as performed by the coding team by utilizing ICD-9 and CPT coding classification systems. Review of patient records will be conducted via e-Web Coding technology, facility EMR, or other established method. This position will perform any and all related job duties as assigned.

Essential Job Functions
  • Computer Literacy
  • Advanced Coding Skills, ICD-9-CM and CPT
  • Excellent verbal and written Communication Skills
  • Strong  knowledge of governmental regulations relating to coding
  • High level of productivity
  • Ability to work independently
  • HIPAA compliant work stations
  • Strong working knowledge of  Protected Health Information
Duties and Responsibilities
  • Ensure 5% coding quality review (or percentage stipulated in client contract) of each coder’s work is conducted monthly for those facilities the reviewer is assigned. Coding quality review will be conducted to identify abstracting (to include dc disposition and POA indicators), ICD-9-CM, CPT, modifier, and HCPCS coding errors for codes assigned by the coding team. Run productivity reports (when requested) to ensure review percentages are met.
  • Review coding and abstracting on all patient types assigned to include the following: inpatient, ambulatory surgery, observation, ER, clinic and diagnostics in order to assure 95% coder accuracy (or as stipulated by client contract).
  • Become familiar with any facility specific coding guidelines and know where to access on the portal.
  • Required to read all Coding Clinics updates and stay abreast of all new coding guidelines
  • Ensure code recommendations are supported with AHA Coding guidelines and/or other appropriate references.
  • Performs chart reviews and coding recommendation notifications (to ensure appropriate turnaround times) to coding team in a timely manner.
  • Enters review findings in a timely manner for each account reviewed into CodeStar or e-web software.
  • Communicates in a professional, non-threatening manner with the coding team in coding quality recommendation discussions.
  • Notifies IQC Coding Director of coder/review disagreements and allows IQC Coding Director to make final decisions.
  • Notify IQC Coding Director when coding risk areas and error trends are identified for a specific facility and/or coder.
  • Assist Coders in answering coding/abstracting questions resulting from the quality reviews.
  • Reviews monthly and quarterly coder quality reports and performs intensification reviews for Coders who fall below the stipulated accuracy rate as part of the corrective action plan.
  • Maintain a working knowledge of ICD-9-CM and CPT coding principles, governmental regulations, official coding guidelines, and third party requirements regarding documentation and billing.
  • Ability to maintain average review productivity standards as follows:  Inpatients 3 charts per/hr, outpatient surgery 3-4 charts per/hr, emergency room/clinics 15 charts per/hr, emergency room with E/M 11 charts per/hr, ancillary/diagnostic 20 charts per/hr.  This excludes outliers.
  • Complete review activity summary daily (productivity summary) for each facility and submit to IQC Director and VP of Quality on a weekly basis.
  • Review and be familiar with the annual review criteria standards as well as DRG review calendar.
  • Assists as needed in the review of external coding audit company findings and formulates a response to be used in the defense of the codes assigned.
  • Participates in client conference calls and weekly quality team stand-up calls. Responsible to review the minutes of these calls if not able to dial into the conference call (minutes are posted on the portal).
  • Provide company support for the creation, maintenance and ongoing operation of an efficient and accurate Quality Improvement Plan that is compliant with Local, State, and Federal Government Regulations.
  • Work with the Coding Solutions Division to provide on-going coding education resulting from the Quality Reviews.  This will involve direct one-on-one correspondence between the coder and reviewer.
  • Maintain open lines of communication serving as a liaison between client, Coders, and Coding Solutions Division to insure that all parties are kept up to date on specific hospital guidelines/policies.
  • Participate in company Coding Solutions Division Meetings.
  • Reviewer must be able to work independently while maintaining specific productivity standards.
  • Basic computer skills are needed to handle connection issues, downloads and to review specific programs.
  • Reviewer downtime must be reported immediately to the administrative staff to ensure adequate work flow.
  • E-web or facility access system problems should be reported to administrative staff and e-web immediately.
  • Reviewers are responsible for checking the Cymetrix email system at least every two hours during review session.
  • Reviewers must maintain their current professional credentials while working for Cymetrix.
  • Reviewers are responsible for maintaining HIPAA compliant work stations (reference HIPAA work station policy)
  • Reviewers are responsible for maintaining patient privacy at all times (reference company handbook policy compliance section 105)
  • Reviewers are responsible for signing a confidentiality statement.
  • It is the responsibility of each reviewer to review and adhere to the coding division policy and procedure manual content.
  • Works well with other members of the facilities coding and billing team to insure maximum efficiency and reimbursement for properly documented services.
  • Communication in emails should be professional at all times (reference e-mail policy).


United States (Nationwide)