QA SpecialistHCM Nexus

Responsible for conducting a second-line review on clinical and/or medical coding, providing audit feedback/education, AND providing trends analysis and resolution on coding reviews. This requires the ability to perform accurate and complete data entry of Protected Health information (PHI), diagnosis codes, certain medical record reviews, and other related duties.
Responsibilities:
SECOND-LINE REVIEW
- Responsible for auditing medical data applied into electronic health record
- Responsible for reviewing physician notation, diagnostics, and other medical documentation in an EMR system
- Responsible to register electronic health information into the EMR
- Responsible for reviewing assigned medical records and apply appropriate diagnosis codes (and/or modifiers) to generally accepted CMS coding guidelines using ICD9/ICD10
AUDIT FEEDBACK
- Responsible for providing feedback and coaching support for audit findings
- Responsible for providing trend analysis and resolution on process workflows
CODING EDUCATION
- Responsible for using QA data for calibration and/or process cascades
- Responsible for identifying, consolidating, and reporting coding findings (either ICD10 or CPT codes) for clinical documentation improvement - Responsible for providing coding education on QA trends, FAQs, and Coding updates
Qualifications:
Education
- Registered Nurse or Allied Health equivalent with 3+ years experience in Adult Care/Medical/Surgical practice
- AAPC/AHIMA Certification with ICD10 Proficiency
Work Experience
- at least 3 years (combined) experience in the field of Healthcare processing, Clinical practice, US Healthcare
- at least 1 year experience in Evaluation and Management Coding
Skillset
- Competent collaboration skills
- Competent communication skills
- Strong proficiency in Windows OS, Microsoft Office applications, and CRM - Basic to Proficient knowledge on US Healthcare, HIPAA, Revenue Cycle Management and relative business
HCM Nexus

Manila City, Metro Manila
Permanent
Full-time