Job Description

Job Title: Manager RAC Appeals/Compliance

Location: System Business Office

Department Name: HIM - Coding Quality

Req #: 0000210060

Status: Salaried

Shift: Day

Pay Range: $110,000.00 - $155,000.00 per year

Pay 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.

Job Overview:

The Manager of Quality Officer Reviews is responsible for supervising reviews through the use of the PWC SMART application and Jzanus algorithms for flagging of inpatient accounts across all acute care sites in the RWJBH System. The Manager must ensure the accuracy and integrity of ICD-10-CM/PCS coding and DRG assignment for encounters. 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. The Manager of Quality Officer Reviews is responsible for managing multiple work queues and providing feedback regarding reviews.

Qualifications:

Education/Experience:

• Must have at least one of the following credentials: RHIA, RHIT, or CCS with at least 8-10 years of coding experience.
• Must have three to five years of experience in a managerial position.
• Ability to be proactive and able to prioritize multiple tasks in order to meet established deadlines.
• Must have excellent interpersonal, oral, and written communication skills.
• Must be capable of critical thinking and analysis and written conveyance of same.
• Must have excellent organizational and time management skills.
• Must maintain a professional demeanor.
• Must be able to work independently and cooperatively with minimal supervision.
• Must foster positive relationships with fellow co-workers and the Quality Officer team.

Special Equipment/Skills

• Must be able to utilize a personal computer with Windows and Microsoft Office software.
• Must be able to utilize Epic, 3M Coding and Reimbursement program, Citrix, and SMART Software systems.Typical office environment with copiers, fax machines, computers, etc.
• May work from home with System provided equipment in an approved environment at the discretion of the VP of HIM Coding and CDI.Should any equipment be found to be non-functioning, the employee will be required to travel to the office.

Scheduling Requirements:

• Full-Time, Day, Salaried

Essential Functions:

• The Manager of Quality Reviews is responsible for supervising the reviews through the use of the PWC SMART application and Jzanus algorithms for flagging of inpatient accounts across all acute care sites in the RWJBH System.

• Ensures the accuracy and integrity of ICD-10-CM/PCS coding and DRG assignment for inpatient encounters. 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).

• Responsible for managing multiple work queues and providing guidance based on review.

• Review and follow-up of accounts in designated work queues (including but not limited to: SMART disagrees, Jzanus disagrees, quality referrals, CDI referrals, QO referrals) to be sure accounts are reviewed, resolved and released timely to mitigate the impact on the DNB.

• Attends assigned corporate meetings to provide coding guidance expertise.

• Works collaboratively with the Manager of HIM Quality Officer Review - Operations

• Provides educational feedback to the Coding vendor based upon reviews.

• Provides educational support to Quality Officers and implements corrective action plans based on trends identified by internal and external reviews.

• Provides monthly educational sessions to the Quality Officers.

• Responsible for the review of the quality of the Quality Officer’s recommendations. The consequences of incorrect judgments affecting the DRG and or data quality may include increased monitoring which could result in progressive disciplinary action.

• Works as a team with other Quality Officers to ensure review goals are met.

• Assures that Quality Officers review 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 appropriate.

• Assures Quality Officers review for Present on Admission (POA) indicators for all diagnosis coded and entered by coders for accuracy and completeness.

• Assures Quality Officer reviews Physician Queries submitted by staff for necessity, accuracy and completeness and communicate recommendations to the sites as appropriate.

• Assures Quality Officer reviews for the presence of all documented diagnoses and procedures for PSI’s, HAC’s, Elixhauser and SDOH.

• Maintains proper documentation of all review activity.

• Oversight for effectively communicating recommendations and rationale to the Quality Officer Team.

• Performs regulatory coding research as needed.

• Collaborates with the Coding Specialists.

• Provides back up to Manager, Quality Officer Review – Operations.

• May be required to perform other related 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 market-competitive Total Rewards package provides comprehensive benefits and resources to support our employees’ physical, emotional, social, and financial health.

• Paid Time Off (PTO)
• Medical and Prescription Drug Insurance
• Dental and Vision Insurance
• Retirement Plans
• Short & Long Term Disability
• Life & Accidental Death Insurance
• Tuition Reimbursement
• Health Care/Dependent Care Flexible Spending Accounts
• Wellness Programs
• Voluntary Benefits (e.g., Pet Insurance)
• Discounts Through our Partners such as NJ Devils, NJ PAC, 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

RWJBarnabas Health is an Equal Opportunity Employer

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