Senior Internal Quality Reviewer, HIM
AMN Healthcare Inc.

Job Description

Welcome to AMN Healthcare: Where Your Career Becomes the Next Big Success Story!

Ever wondered what it takes to build one of the largest and most successful healthcare staffing and total talent solutions companies? It takes trailblazers, innovators, and amazing people like you. At AMN Healthcare, we don't just offer jobs; we pave the way for incredible careers.

Why AMN Healthcare? Because You Deserve the Best:

• Forbes Recognition: We don't just make lists; we make headlines. AMN Healthcare proudly claims a spot on Forbes' prestigious lists not once, but twice! We're among the "Best Large Employers for Women," a testament to our commitment to excellence.
  
• SIA Approval: Acknowledged by Staffing Industry Analysts (SIA) as one of the "Rapidly Advancing Staffing Firms," we have no plans to decelerate in the future.
  
• Incredible Futures: Join a team that doesn't just talk about building the future; we're shaping it. Discover how AMN Healthcare is crafting incredible futures, one amazing career at a time.
  

Job Summary

The Senior Internal Quality Reviewer, Health Information Management will be an expert resource to the Manager of Internal Quality, Lead Auditors, Fellow Auditors, Coding Work Force Managers, and Coder staff.

This position is accountable for auditing and providing education for Pro-Fee and Outpatient (Sames Day Surgery/SDS, Observation/OBS, Emergency Room/ER, and Ancillary) Coders and Revenue Cycle Solutions Consultants and will ensure client satisfaction.

Job Responsibilities

• Conducts initial pre-bill and/or onboarding reviews and monthly audits for Revenue Cycle Solutions Consultants per designated schedule.
• Audits and analyzes coded data to identify aberrant coding practices that do not fall in line with established coding policies and procedures. Coordinate and provide feedback to coders and when necessary, Work Force Managers.
• Continuously meets productivity expectations, per complexity indices, determined for each client specifically to the area audited.
• Maintains daily schedule and covers audits for Pro-Fee and Outpatient (Sames Day Surgery/SDS, Observation/OBS, Emergency Room/ER, and Ancillary) Coding and assists when gaps are identified.
• Proactively takes action to ensure all client commitments are met.
• Completes all assigned audits by the 5th of the following month.
• Responds to management within 1 - 2 business hours, unless otherwise determined by the manager.
• Respond to Coding Consultant Rebuttal responses within 24 hours for Pre-bill/Onboarding Audits and within 24 hours for Monthly Audits.
• Compiles and follows through on all processes entailed in audits and client obligations.
• Identifies trends in Pro-Fee and Outpatient coding, as well as Diagnosis-Related Group (DRG) and Ambulatory Payment Classification (APC) validation, and recommends focus areas for further coding education to Workforce Manager (WFM) and Internal Quality Manager.
• Adheres to the 'Standard Terminology for Auditor Recommendations' Policy.
• Uses industry-recognized references to support their review findings, such as the ICD-10 Official Guidelines for Coding and Reporting, American Health Information Management Association (AHIMA) Standards of Ethical Coding, Practice Briefs related to compliant querying, and Coding Clinics.
• Updates systems with all vital audit information within 24 hrs. of an audit being finalized.
• Assists clients and coders with coding, query writing, and audit questions and provides education to coders when audits are below 95% as requested.
• Timely communicates with the Manager, Internal Quality in response to customer-related issues, and any internal audit-related questions, to ensure a successful experience.
• Develops and maintains supportive and positive relationships with all employees and performs miscellaneous job-related duties as needed.

Key Skills

• Excellent organizational and computer technical skills.
• Proficiency with Microsoft Word, Excel, and PowerPoint.
• Ability to use coding references such as (Coding Clinic, Current Procedural Terminology Assistant, etc.).
• Ability to perform multiple audits and meet deadlines.
• Ability to handle conflict and offer actionable resolution.

Qualifications

Education & Years of Experience

• Bachelor's Degree plus 3 + years of work experience OR High School Diploma/GED plus 8-10 years of work experience
  

Certifications

• Certified Coding Specialist (CCS) | American Health Information Management Association (AHIMA) | OR Certified Professional Coder (CPC) | American Academy of Professional Coders (AAPC) | Required
• Certified Professional Medical Auditor (CPMA) (AAPC) | Preferred
• Registered Health Information Administrator (RHIA) | American Health Information Management Association (AHIMA) | Preferred
• Registered Health Information Technician (RHIT) | American Health Information Management Association (AHIMA) | Preferred

Additional Experience

• Experience with various Encoder software programs.
• Basic understanding of healthcare billing/accounting systems/healthcare revenue cycle.
• Understanding of physician query processes.

Work Environment / Physical Requirements

• Work is performed in an office/home office environment.
  
• Team Members must have the ability to operate standard office equipment and keyboards.
  

AMN Healthcare will provide reasonable accommodations to qualified individuals with disabilities to enable them to perform the essential functions of the job.

Our Core Value

Respect • Passion • Continuous Improvement • Trust • Customer Focus • Innovation

At AMN Healthcare, our diversity, equity, and inclusion philosophy is grounded in the belief that we should respect all voices, seek different perspectives, and succeed when we act together as a positive force for all of humanity. AMN Healthcare strives to foster a workplace of belonging where all team members can be their authentic selves, and where we can apply our collective skills to innovate solutions that empower the future of care. AMN Healthcare is an equal-opportunity employer.

Pay Rate
$35.25 - $41.75 Hourly
Final pay rate is dependent on experience, training, education, and location.

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