Navigant Coding Quality Reviewer (Pro- Fee) - Navigant Cymetrix- Remote Location in GARDENA, California

Navigant Consulting, Inc. (NYSE: NCI) is a specialized, global professional services firm that helps clients take control of their future. Navigant’s professionals apply deep industry knowledge, substantive technical expertise, and an enterprising approach to help clients build, manage and/or protect their business interests. With a focus on markets and clients facing transformational change and significant regulatory or legal pressures, the Firm primarily serves clients in the healthcare, energy and financial services industries. Across a range of advisory, consulting, outsourcing, and technology/analytics services, Navigant’s practitioners bring sharp insight that pinpoints opportunities and delivers powerful results. More information about Navigant can be found at navigant.com.

Navigant Cymetrix unites the strengths of four category-leading companies to address the complexities of today’s healthcare system. We design, develop and implement integrated, patient-centered solutions for sustained improvements in performance and profitability, working collaboratively across a spectrum of customers that encompasses hospitals, health systems, physician practice groups and payers.

The Coding Quality Reviewer- (Pro Fee) shall report directly to the Internal Quality Control Coding Director and will be responsible for accessing and reviewing the medical record documentation, coding and abstracting accuracy as performed by the Navigant Cymetrix coding team by utilizing ICD-10 and CPT coding classification systems. Review of patient records will be conducted via facility EMR, scanning technology or other established method. This position will perform any and all related job duties as assigned.

  • Computer Literacy.

  • Excellent verbal and written Communication Skills.

  • High level of productivity.

  • HIPAA compliant work stations.

  • Advanced Coding Skills, ICD-10-CM and CPT.

  • Strong knowledge of governmental regulations relating to coding.

  • Ability to work independently.

  • Strong working knowledge of Protected Health Information.

  • Ensure 5% coding quality review ( or percentage stipulated in client contract ) of each coder’s work is conducted monthly for those facilities the reviewer is assigned. Coding quality review will be conducted to identify abstracting (to include dc disposition and POA indicators), ICD-9-CM, CPT, modifier, and HCPCS coding errors for codes assigned by the coding team (see quality review policies for review details).

  • Reviewer will run coder productivity reports (where applicable) to ensure review percentages are met per facility contract.

  • Review coding and abstracting on all patient types assigned to include the following: inpatient, ambulatory surgery, observation, ER, clinic and diagnostics in order to assure 96% coder accuracy (or as stipulated by client contract).

  • Become familiar with any facility specific coding guidelines and know where to access on the Navigant Cymetrix portal.

  • Required to read all Coding Clinics updates and stay abreast of all new coding guidelines.

  • Ensure code recommendations are supported with AHA Coding guidelines, Coding Clinics, CPT Assistant and/or other appropriate coding references.

  • Perform chart reviews and coding recommendation notifications (to ensure appropriate turnaround times) to coding team in a timely manner (same day review conducted).

  • Communicates in a professional, non-threatening mentorship manner with the coding team in coding quality recommendation discussions.

  • Follows review escalation policy when coder/review disagreements occur (see quality.

  • Notify Coding Manager when coding risk areas and error trends are identified.

  • Assist Coders in answering coding/abstracting questions resulting from the quality reviews.

  • Reviews monthly and quarterly coder quality reports and performs intensification reviews for Coders who fall below the stipulated accuracy rate as part of the corrective action plan.

  • Maintain a working knowledge of ICD-10-CM and CPT coding principles, governmental regulations, official coding guidelines, and third party requirements regarding documentation and billing.

  • Ability to maintain average review productivity standards as follows: Inpatients 1 chart per/hr, AMB 4.25 charts per/hr, emergency department 6.25 charts per/hr, Pathology 30 charts per/hr. This excludes outliers.

  • Complete monthly Quality summary and submit to Coding Manager.

  • Review and be familiar with the audit plan.

  • Assist as needed in the review of external coding audit company findings and formulates a response to be used in the defense of the codes assigned.

  • Provide company support for the creation, maintenance and ongoing operation of an efficient and accurate Quality Improvement Plan that is compliant with Local, State, and Federal Government Regulations.

  • Work with the Coding Manager to provide on-going coding education resulting from the Quality Reviews. This will involve direct one-on-one correspondence between the coder and reviewer.

  • Maintain open lines of communication serving as a liaison for coders.

  • Participate in meetings as requested.

  • Reviewer must be able to work independently while maintaining specific productivity standards.

  • Basic computer skills are needed to handle connection issues, downloads and to review specific programs.

  • Reviewer downtime must be reported immediately to the Coding Manager to ensure adequate work flow.

  • Facility access system problems should be reported to administrative HIM team, facility IT and Navigant Cymetrix help desk immediately.

  • Reviewers are responsible for checking and responding to Navigant Cymetrix email system at least every two hours during review session AND the client secure email system.

  • Reviewers must maintain their current professional credentials while working for Navigant Cymetrix.

  • Reviewers are responsible for maintaining HIPAA compliant work stations (reference HIPAA work station policy).

  • Reviewers are responsible for maintaining patient privacy at all times (reference company handbook policy compliance section 105).

  • Reviewers are responsible for signing a confidentiality statement.

  • It is the responsibility of each reviewer to review and adhere to the coding division policy and procedure manual content.

  • Works well with other members of the facilities coding and billing team to insure maximum efficiency and reimbursement for properly documented services.

  • Communication in emails should be professional at all times (reference e-mail policy).

  • Must hold one of the following credentials: (RHIT, RHIA, CCS, CPC-H, CPC-P).

  • Must have previous experience in Professional Services (Pro-Fee) auditing inculding in evaluation and management (E/M) and surgeries

  • Must maintain coding credential while employed by Navigant Cymetrix.

  • Must have three years of coding or review experience.

  • Abide by all client policies and procedures.

  • Abide by all Navigant Cymetrix policies and procedures.

  • Personal responsibility, respect for self and others, innovation through teamwork, dedication to caring and excellence in customer service.

Information System Requirements:

  • Computer and monitors provided by Navigant Cymetrix.

  • Internet Access with DSL or high speed connectivity.

  • Remote office location that meets HIPAA privacy requirements.

  • Strong conceptual, as well as quantitative and qualitative analytical skills

  • Work as a member of a team as well as be a self-motivator with ability to work independently

  • Constantly operates a computer and other office equipment to coordinate work

  • Regularly uses close visual acuity and operates computer equipment to prepare and analyze and transmit data

  • Generally works in an office environment

Navigant Cymetrix is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information or any other basis protected by law, ordinance, or regulation.

Navigant will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.