Senior Quality Assurance Clinical Professional - Work at home nationwide

Profile

Description

The Senior Quality Assurance, Clinical Professional requires being both a nurse/RN and a certified Coder nurse as this position will be cross trained to review DRG (Diagnosis Related Group) audits as well as HCC (Hierarchical Condition Categories) audits.

This position consults and collaborates with clinicians to ensure high accountability of compliance and quality and will work assignments involving moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The hours are Mon-Fri with flexible scheduling between the hours of 6am- 6pm.

Required Qualifications:


Registered Nurse with active license in state of residence
Certification from AAPC or AHIMA (CPC, CCS, CIC, CRC, CCDS, CDIP, CPMA or equivalent)
2 years of inpatient and outpatient medical record review and auditing experience.
Demonstrated ability to apply critical review judgment to make clinical determinations
Knowledge of inpatient and outpatient coding conventions and standards
Working knowledge Microsoft Word, Excel and PowerPoint
High level of emotional intelligence and strong communication skills
Ability to work independently and manage work load


Work at Home/Remote Requirements


Must ensure designated work area is free from distractions during work hours and virtual meetings
Must provide a high-speed DSL or cable modem for a workspace (Satellite, wireless and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required


Preferred Qualifications:


Minimum of 3-5 years of general nursing experience (Med/Surg, ED, ICU preferred)
Extensive regulatory coding (ICD-10-CM, MS-DRGs, Hospital Acquired Conditions (HACs), POA assignment, and Discharge Disposition codes) and associated reimbursement knowledge
Experience in HCC (Hierarchical Condition Categories) coding documentation guidelines and compliance rules
Must demonstrate working knowledge of clinical indicators, risk factors and treatment protocols used for clinical validation and appropriate code assignments
Solid understanding of anatomy and physiology, diagnostic procedures, and surgical operations.
Experience with multiple EHR systems and Quality Assurance reviews
Experienced with effective collaborative training to support and improve clinical nurse auditor's quality


Scheduled Weekly Hours

40

Company info

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