McLaren Health Care is a fully integrated health network committed to quality, evidence-based patient care with locations in Michigan, Indiana and Ohio. The McLaren system includes 14 hospitals in Michigan and Ohio, ambulatory surgery centers, imaging centers, a primary and specialty care physician network, commercial and Medicaid HMOs, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, one of only 51 National Cancer Institute-designated comprehensive cancer centers in the U.S.

Position Summary: Responsible for working with physicians, coders, ancillary department staff, clinical documentation improvement (CDI), and other allied health professionals to improve documentation of patient care and to appropriately assign codes and/or determine charges to support those services.

Essential Functions and Responsibilities:

Completes quality assurance audits on inpatient and outpatient coding specialists, onboarding audits and training of newly hired coding specialists, validating the coding specialist is accurately abstracting data into medical record systems, following the all coding guidelines and directives.

Validates Present on Admission (POA) indicators according to guidelines and identifies any missing or inappropriate queries to providers.

Uses payment methodology to audit outpatient facility coding and billing, APC assignment, and OPPS reimbursement methodology and shares knowledge with colleagues and clinical team members.

Performs retrospective, random and focused audits of coding cases to ensure accurate code application and overall coding quality.

Performs pre-bill compliance audits to ensure accurate code assignment, application of coding guidelines, and compliance with external regulatory and accreditation requirements.

Identifies solutions to improve the overall data quality of the health records and to assure that appropriate reimbursement is obtained for services provided.

Completes all regularly scheduled quality assurance reviews for coding, communicates quality issues to management as appropriate.

Maintains reports and accuracy rates for coders and assists with identification, drafting, implementation, and monitoring of quality improvement action plans for coders.

Per Centers for Medicare & Medicaid Services (CMS) regulations, all McLaren employees must be vaccinated for COVID-19 by January 4, 2022. The regulation permits exemptions for employees with qualified medical disabilities or religious beliefs.

McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.