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Job Title: Quality Officer IIILocation: System Business OfficeDepartment Name: HIM - Coding QualityReq #: 0000221717Status: SalariedShift: DayPay Range: $87,313.00 - $123,330.00 per yearPay Transparency: The above reflects the anticipated annual salary range for this position if hired to work in New Jersey.The compensation offered to the candidate selected for the position will depend on several factors, including the candidate's educational background, skills and professional experience.The position is remote, but candidates must be based in New Jersey, New York or Pennsylvania.Job Overview:The Quality Officer III is responsible for ensuring accuracy and integrity of ICD-10-CM/PCS coding and DRG assignment for inpatient Medicare encounters.  The Quality Officer III must also sustain an excellent organizational average accuracy rate. Adherence to applicable Federal and State Regulations, Compliance Guidelines, and Coding Guidelines set forth by RWJBH, American Hospital Association (AHA) and the American Medical Association (AMA) must be maintained.Qualifications:Required:Bachelor's degree and 5+ years experience within acute care coding and/or auditing with a concentration on inpatient Medicare records or 9+ years of experience within acute care coding and/or auditing with a concentration on inpatient Medicare records in lieu of a Bachelor's degreeExtensive knowledge of ICD-10-CM/PCS and CPT coding, medical terminology, human anatomy and physiology, clinical indicators associated with disease processes and pharmacologyKnowledge of Medicare and Medicaid billing and coding regulationsExcellent interpersonal, oral and written communication skillsExcellent organizational and time management skillsMust be able to work independently and cooperatively with minimal supervisionPreferred:CPC-H, RHIT, RHIA and/or RN licensureCertifications and Licenses Required:CCS certificationScheduling Requirements: Shift working, 8:00am - 4:30pm each dayMonday - FridayFull TimeRemoteEssential Functions:Ensures the accuracy and integrity of ICD-10-CM/PCS, CPT coding when applicable and DRG assignment for adherence to Federal and State Regulations and Compliance GuidelinesCritically analyzes each Medicare inpatient medical record to apply appropriate coding, DRG judgements, SOI, ROM and POAIndependently manages SMART pending queues for all acute care RWJBarnabas facilities. Reviews ICD-10-CM/PCS coding and DRG assignment of medical records as "flagged" by SMARTIndependently manages EPIC SMART WQ's to assure proper workflow of identified accountsDirects coders with appropriate case-specific recommendations. Educates and coaches coders in the application of coding principles, code assignment and sequencing, DRG assignment and clinical disease processes. Coding advice must be clearly and concisely written with appropriate clinical indicators cited. Additional facilities that may join the System receive the same education and coaching from the Quality Officers to ensure a unified methodology within the RWJBH organization. This results in improved outcomes in DRG assignment, coder education and DNB lag time within all facilitiesSustains an excellent organizational average accuracy rate by leveraging advanced knowledge of coding practices leading to exceptional resultsThe Quality Officer's coding analysis is reviewed by the Coding Specialists on a biannual basis. The consequences of incorrect judgments affecting the DRG may include an increased monitoring, until quality scores of 90% or better for two consecutive months are obtained. The consequences of incorrect coding resulting in erroneous DRGs includes under reporting and/or over reporting. Incorrect coding may result in an incorrect reporting of diagnoses and procedures to the patient's EHR which may affect the patient's future care, insurance claims and coverage. When accounts are not reviewed and released in a timely manner, there is a detrimental impact to the reimbursement flow for the facility (DNB)Productivity Standards must be met for all Quality Officers. Failure to meet productivity standards will result in progressive disciplinary actionProvides Guidance to Quality Officer 1 and 2 as requestedIndependently monitors SMART queues to ensure all records imported by SMART are reviewed and properly directed, with/or without coding or other recommendations, or released to billing as appropriate and within department accepted timelinesWorks as a team with other Quality Officers to ensure SMART review goals are met for all RWJBarnabas facilitiesMay review ICD-10-CM/PCS coding associated with RAC audits and/or other additional medical records as needed, and provides appropriate written feedback including rationale, research, and coding guidelines to management and/or the Coding SpecialistsReviews Discharge Status, Admission and Discharge Dates, and other related demographic information coded and entered by affiliate staff for accuracy and completeness. Communicates the need for Case Management review to the RWJBarnabas facilities when appropriateReviews Present on Admission (POA) indicators for all diagnosis coded and entered by coders for accuracy and completenessReviews Physician Queries submitted by staff for necessity, accuracy and completeness and communicate recommendations to the sites as appropriate.Participates in the review of other payers as directedIndependently reports problems with any and all computer system to RWJBarnabas IT&S or SMART helpdesk for resolutionMay perform classroom training in ICD-10-CM/PCS and CPT coding for affiliate staff when needed at the internal RWJ Barnabas Coding School which may be held to train new facility codersMaintains proper computer and written records of all review activityEffectively communicates coding recommendations and rationale to Coding team.Performs regulatory coding research as neededOther Duties: Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. Benefits and Perks:At RWJBarnabas Health, our employees are at the heart of everything we do. Driven by our Total Wellbeing promise, our market-competitive offerings include comprehensive benefits and resources to support our employees' physical, emotional, financial, personal, career, and community wellbeing.  These benefits and resources include, but are not limited to:Paid Time Off including Vacation, Holidays, and Sick TimeRetirement Plans Medical and Prescription Drug Insurance Dental and Vision Insurance Disability and Life Insurance Paid Parental LeaveTuition ReimbursementStudent Loan Planning SupportFlexible Spending AccountsWellness Programs Voluntary Benefits (e.g., Pet Insurance)Community and Volunteer OpportunitiesDiscounts Through our Partners such as NJ Devils, NJ PAC, and Verizon....and more!Choosing RWJBarnabas Health! RWJBarnabas Health is the premier health care destination providing patient-centered, high-quality academic medicine in a compassionate and equitable manner, while delivering a best-in-class work experience to every member of the team.  We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time.  As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health.  RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey"”whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education.Equal Opportunity Employer