QA Compliance Specialist, Health Information Management

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QA Compliance Specialist, Health Information Management

Exciting Opportunity at MSK: We are hiring a QA Compliance Specialist to join our Health Information Management outpatient team.

Role Overview:

• Monitor and maintain compliance by performing reviews and formal audits validating ICD-10-CM/PCS and/or CPT-4 codes, modifiers, as well as Evaluation/Management and medication administration for coding/charge processing.
• Communicate directly with HIM Leadership, clinical staff, Patient Accounts to ensure that clinical documentation is in compliance with CMS/other third party carriers, JCAHO and HIPAA standards/regulatory requirements.
• Participate/coordinate reviews of third party payors and provides documentation to fulfill external audit requests, as well as special projects involving data management.
• Work largely independently within defined objectives/responsibilities by operating at a multi-faceted level and promoting solutions.

Key Qualifications:

• At least 4 years experience with medical terminology, anatomy & physiology, ICD10CM/PCS, CPT and/or EM coding, hospital billing, medical records.

Core Skills:

• Ability to express position/opinions in a team conversation in an effective manner.
• Understanding of hospital billing processes, including flow of data from clinical departments/HIM into billing systems.
• Ability to understand complex work assignments and government regulations, applying rules to reviews/audits; knowledge/ability to use PC applications, including Excel and Microsoft Word, to develop/analyze reports with the capability to recognize and recommend enhancements among the different systems.
• Analytic skills include basic math, statistics and problem solving techniques to identify trends.
• Ability to navigate through various clinical/charging applications/databases.
• Organizational skills and attention to detail, in order to effectively manage/maintain large amounts of complex data in an accurate/legible manner.
• Ability to effectively communicate with all staff in a clear, concise and professional manner, as well as explain/provide guidance and share information to less experienced staff.

Additional Information:

• Location: Hybrid; when on site 633 Third Avenue in NYC
• Schedule: Monday – Friday, 9 am – 5 pm (flexibility to start as early as 6:30 am)
• Reporting to the Manager 1, Health Information Management

Pay Range: $66,500.00 - $103,100.00/annually

Helpful Links:

• MSK Compensation Philosophy
• Review Our Greats Benefits Offerings

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