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Outpatient Data Quality Specialist (Medical Group Coder)

Department:  COMMUNITY MEDICINE ADMIN

Job Details

Req Id    62582 
Department    COMMUNITY MEDICINE ADMIN 
Shift   Days
Shift Hours Worked    8.00 
FTE    
Work Schedule    GENERAL UNION 05 
Employee Status    A1 - Full-Time 
Union  CWA FSL SERVICE AND MAINTENANCE

Job Summary

The Professional Data Quality Specialist reviews and analyzes medical records to accurately select all forms of HCPCS service codes and ICD-10-CM codes for professional services to include office or other outpatient settings and/or inpatient settings.  The Professional Data Quality Specialist follows the mission, vision, I-CARE values, policies and procedures of Mohawk Valley Health System. 

Core Job Responsibilities

  • Coding of HCPCS services - The Professional Data Quality Specialist reviews medical records to determine and code applicable CPT, CPTII, CPTIII, modifiers and HCPCS Level II codes for professional services performed in the outpatient and/or inpatient setting.  Services are to be coded within a timely manner of receipt of completed records/registrations.  If records/registrations are not complete, the Professional Data Quality Specialist communicates with providers, managers, or registration staff to resolve outstanding issues.  In collaboration with business office personnel, ensures that any coding errors or insurance denials are worked within a timely manner.
  • Coding of ICD-10-CM codes - The Professional Data Quality Specialist reviews medical records to determine and code the highest level of applicable ICD-10-CM code(s) for professional services performed in the outpatient and/or inpatient setting.  Diagnoses are to be assigned within a timely manner of receipt of completed records/registrations. If records/registrations are not complete, the Professional Data Quality Specialist communicates with providers, managers, or registration staff to resolve outstanding issues.  In collaboration with business office personnel, ensures that any coding errors or insurance denials are worked within a timely manner.
  • Compliance/Regulatory Responsibility - The Professional Data Quality Specialist performs duties in accordance with hospital wide guidelines, departmental procedures, and coding guidelines and regulations as established by the Centers for Medicare and Medicaid Services, American Medical Association, Office of the Inspector General, American Health Information Management Association, American Academy of Professional Coders and insurance company standards. 
  • Privacy and Security - The Professional Data Quality Specialist maintains patient confidentiality and information security in accordance with hospital wide and Federal and State HIPAA Privacy and Security guidelines.
  • Service Excellence - The Professional Data Quality Specialist provides service excellence to patients through careful, mindful code selections that accurately reflect services provided and corresponding diagnoses for services.   When corresponding with providers, managers, registration staff, business office personnel and other internal customers, the Professional Data Quality Specialist exhibits professionalism, patience and clarity, as well as upholding all of the I-CARE values.

Education Requirements

Required: None
Preferred: Knowledge of medical terminology, human anatomy and physiology, ICD-10-CM, CPT-4 and HCPCS, typing skills, use of Excel

Licensure/Certification Requirements

Required: CPC, CCS-P, or related AHIMA or AAPC professional certification
Preferred: Minimum one (1) year of professional coding experience

EOE AA M/F/Vet/Disability

Qualified applicants will receive consideration for employment without regard to their age, race, religion, national origin, ethnicity, age, gender (including pregnancy, childbirth, et al), sexual orientation, gender identity or expression, protected veteran status, or disability.

Successful candidates might be required to undergo a background verification with an external vendor.


Nearest Major Market: Utica