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The incumbent will be responsible for identifying and addressing information and data gaps to support KRNs verticals Corporate Investment and Credit (CIC), Innovation (ICF)/Women Ventures (WV) and Digital Financial Services (DFS) so that they are able to make informed investment decisions and design evidence-based interventions.
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Liaison with KRNs internal streams CIC, ICF/WV and DFS to understand their research and knowledge requirements. We are supported by Foreign, Commonwealth & Development Office (FCDO) and Bill and Melinda Gates Foundation (BMGF.
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1 year inpatient coding experience and Coding Certificate (Certified Coding Specialist (CCS), RHIT, RHIA, or Certified Inpatient Coder (CIC); OR Bachelor’s degree in HIM and Coding Certificate (CCS, RHIA, or CIC); OR Associate's degree in HIM and Coding Certificate.
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Health information management and/or coding credential from AHIMA and/or AAPC required (RHIA, RHIT, CCS, and/or CIC) Health information management and/or coding credential from AHIMA and/or AAPC required (RHIA, RHIT, CCS, and/or CIC.
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Solid command of anatomy, physiology, pathology, laboratory, imaging, pharmacology, disease assessment, patient management, and treatment. Knowledge of AHRQ Quality Metrics including patient safety indicators (PSIs), Hospital Acquired Conditions (HACs), Vizient Mortality Models, CMS Core Measures, other national patient safety quality indicators, and different payor categories.
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Clinical license preferred (e.g., LPN, RN, BSN, NP, PA, MD, DO, allied health) Maintains an up-to-date working knowledge of MS-DRG, APR-DRG, ICD-10 CM/PCS coding. CCDS or CDIP certification preferred.
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The Quality Assurance (QA) Specialist is responsible for performance of internal coding QA reviews. Expert knowledge of Official Coding Guidelines, advanced knowledge of APR and MS DRG reimbursement models, state, and federal regulations.
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Ability to provide guidance and training to Accuity coding, physician, and CDI staff. Knowledge of legal, regulatory, and policy compliance issues related to medical coding and documentation. Minimum 2 years code/DRG auditing experience preferred.
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Experience with electronic health records and health information systems as well as different encoders. Advanced knowledge of medical coding, electronic medical record systems, and coding systems. Knowledge of current and developing issues and trends in medical coding diagnosis and procedure code assignment.
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Ability to clearly communicate information to coders, physicians, and CDI staff. Review scope includes validation of the MS-DRGs and APR-DRGs assigned for Medicare, Medicaid, commercial, and third-party claims.
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Independent, focused individual able to work remotely or on-site. These reviews provide an additional layer of internal coding quality and compliance of inpatient (IP) records to assure appropriateness and accuracy of code assignments in accordance with official coding guidelines and client facility specific coding guidelines.
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Maintains turnaround time expectations to minimize impact to client DNFB. Minimum 5 years of hospital inpatient coding and/or inpatient clinical documentation improvement experience required. Performs IP coding quality assurance (QA) reviews.
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Knowledge of quality assurance/healthcare internal auditing concepts and principles. Independent, focused individual who takes initiative and can work remotely. Demonstrated knowledge of all applicable coding clinics as they relate to current IP coding practices.
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Associates Degree required, Bachelor's or Master's degree preferred. Identifies, applies, and validates the use of current industry standard clinical indicators, risk factors and treatment protocols/order sets used in clinical validation of payment impacting code assignment.
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Writes a query ask with clinical indicators and/or documentation excerpts if a discrepancy or gap exists in the medical record documentation and the (base, desired) code assignment per application of Official Coding Guidelines, or if a medical condition does not appear to be clinically supported or meeting clinical criteria requirements.
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cic job
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