Job Description

The Concurrent Quality Reviewer of our hospital reviews documentation in the electronic medical record (EMR) and ensures that accurate assignment and sequencing of ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes in accordance with national coding guidelines. The primary focus of this role is to capture all encounter-specific diagnoses, procedures, and documented conditions for accurate reporting and research purposes. The goal is to achieve concurrent/real time assignment of ICD-10 codes and DRGs. This will be achieved by optimizing accuracy of documentation by collaborating with the providers, CDIs, Coders, Quality, and other relevant multidisciplinary teams. The concurrent inpatient quality reviewer will assign a working DRG, as well as capture and ensure accurate POA assignment, severity of illness, mortality risks, SDOH codes, etc. This position will assist with identifying trends that will be used to develop and provide educational training for CDI teams, providers, etc. Uphold compliance by assigning and sequencing accurate ICD 10 codes to inpatient medical records as per guidelines, demonstrating behavior that reflects integrity, shows a commitment to ethical and legal coding practices, and fosters trust in professional activities. Determines and assigns the principal diagnosis and all significant secondary ICD-10-CM diagnoses as well as Present on Admission (POA) indicator and ICD-10-PCS procedure codes, using official coding guidelines. Validates the accuracy of codes assigned by the computer assisted coding software, recognizing inappropriate application of clinical coding regulations/guidelines, and revising the codes assigned based on expert subject matter knowledge and provider documentation. Literacy and proficiency in computer technology, particularly related to health information and coding applications utilized for daily job performance, are essential. Strong ability to analyze clinical documentation to ensure codes reported are clearly and consistently supported by the health record. Examine and ensure that the MS-DRG, APR-DRG, SOI, and ROM of each inpatient encounter is compatible and compliantly optimized. Familiarity with CCs, MCCs, Elixhauser, and other specialty specific conditions that impact USNWR is given priority. Request clarification from the provider when there is conflicting, incomplete, or incorrect information in the health record regarding a significant reportable condition or procedure or other reportable data element collaborating with the Clinical Documentation Specialists for concurrent queries to the providers, ensuring physician responses to queries are reflected in the code assignment. Abstract relevant information accurately and completely into the computer assisted coding application, including but not limited to present on admission (POA) indicators. Verify and revise according to documentation in the medical record the correct discharge disposition of encounters coded. Confirm the admission status ordered by the physician in the medical record documentation and the registration status of the encounter are compatible with orders. Communicates professionally identified discrepancies, documentation issues, denial management issues and coding concerns in the medical record to the appropriate department and/or leader. Stays up to date with regulatory changes by completing all mandatory educational accountabilities in a timely manner. Maintain coding quality and productivity as per departmental standards. Attends department meetings and other inpatient conferences and seminars as scheduled. Maintain and observe patient confidentiality as outlined in the National Patient Safety Goals and HIPAA guidelines always protecting the confidentiality of the health record and refraining from accessing protected health information not required for coding-related activities. Maintains coding accuracy and productivity standards of ≥ 95%. Attends educational meetings and seminars to maintain certification and continuing education requirements. Prepare ad-hoc reports as requested by senior management. Develops, mentors, educate and provide feedback to providers, CDI, and others as applicable in coding and ICD-10/DRG code assignment. Adheres to University and unit-level policies and procedures and safeguards University assets. This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary. Minimum qualifications include a Bachelor’s degree in a related field such as Business Administration, Health Care Administration, Health Information Management. Certifications such as Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), and/or Certified Inpatient Coder (CIC) are highly desired. Minimum 5 years of coding in an inpatient hospital setting with ICD-10-CM/PCS medical coding experience is required. Strong knowledge of anatomy and physiology, medical terminology, and disease processes. Advanced technical skills for use of MS Office and experience with CAC are required. The role requires strong analytical, organizational, communication, and critical thinking skills, ability to work independently in a remote environment, and commitment to compliance with HIPAA and University policies. The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more. The position is full-time and remote, part of the University of Miami Health System, an academic medical center serving South Florida, Latin America, and the Caribbean.

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