NewWave HQ

  • Quality Review Controller

    Job ID 2019-1191
  • Overview

    NewWave is an information technology company helping businesses and government agencies modernize and thrive by applying the power of technology. NewWave began making a mark in the federal healthcare space in 2004, where we continue to actively modernize systems to improve healthcare’s value for millions of Americans. Since then, our work has expanded across various sectors and industries, where we help our customers stay ahead of the new and make the world in which we live, better.

    Responsibilities

    This position is responsible for quality review/monitoring of Health Plan Coding Specialist Staff/or external coding personnel. They will perform auditing functions including monitoring, coding of diagnosis, reviewing medical record documentation and discharge summaries to determine if appropriate code was assigned to ensure Health Plan compliance with coding standards.

     

    • Assists Manager with research, resolution and response of error appeals/rebuttals
      Communicate effectively with Risk Adjustment Staff, nurse reviewers and physicians and ancillary departments as necessary to address issues and concerns.
    • Compile and report statistical data to internal and external customers
      Completion of special projects including claims and/or coding related audit support.
      Identify error trends to determine appropriate training needs and suggest modification to policies and procedures
    • Maintain employee/insured confidentiality.
    • Provide assistance to other departments as requested.
    • Compile and report statistical data to internal and external customers.
    • Review Diagnosis codes submitted internal/external coders/reviewers and the medical record documentation to ensure the recommended diagnosis code and meets governmental agency requirements for submission.
    • Utilize standard coding guidelines, principles and coding clinics to verify the appropriate ICD-10-CM, CPT codes modifiers, or DRG/APC for accurate coding assignment.
    • Working knowledge of entering audits into the database and use of medical records repository systems

    Qualifications

    • Associates degree from an accredited Health information Management program preferred
    • Three to five years HCC auditing experience
    • Graduate of an AHIMA or AAPC Certified Coding program
    • Five years of coding experience in a health care setting
    • Extensive knowledge of ICD-10 and CPT classifications and coding of diagnoses and procedures is required
    • In depth knowledge of medical terminology, human anatomy/physiology, pharmacology, and pathology is required
    • The ability to problem solve and to communicate in a professional manner with staff and other health care professionals is essential
    • Excellent written and verbal communication skills are essential
    • Proficiency in computer skills required for coding (MARS, Cerner)
    • Detail oriented individual with excellent organizational skills
    • High degree of oral and written communication skills
    • Proficiency in Microsoft Office/PC skills
    • Traveling may be required as necessary.

     

    Required 

    • At least 3 years’ experience providing website development services related to the reporting of health care information targeting general consumer audiences.
    • Three or more required years of experience providing website design and development services related to the reporting of health care information to general consumer audiences.

     

    Licensure and Certifications

    • Certified Professional Coder (CPC) OR Certified Coding Specialist (CCS) OR Registered Health Information Tech (RHIT) OR Registered Health Information Administrator (RHIA)

     

    Interpersonal Skills

    • Excellent interpersonal, communication, and organizational skills.
    • Excellent written and verbal communication skills – must be able to communicate fluently in English both verbally and in writing
    • Should be extremely facts and data oriented.
    • Should be deadline and closure oriented.
    • Strong communication, interpersonal, persuasion, facilitation and influencing skills.
    • High Energy Levels. Should be self-driven.
    • Strong analytical, organizational and project management skills.
    • Demonstrated ability to lead and work with cross functional teams including senior level individuals.
    • Must be able to thrive in a fast-paced, rapidly evolving environment with varying priorities, based on a team building culture.

     

    NewWave is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity/Affirmative Action Employer, making decisions without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class.   NewWave is a proud Veteran friendly employer.

     

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