Clinical Quality Evaluator

•Identifies, documents, and reports any transaction errors or communications issues in a timely manner to ensure

prompt resolution.

•Tracks and trends audit results, providing feedback to management.

• Conduct calibration sessions to evaluate and ensure that all teams are aligned with the set QA guidelines..

• Identifies and reports on systemic issues which create ongoing quality concerns.

• Conducts root cause analysis to determine the underlying causes of noted quality opportunities using the RCA tools.

• Recommend, implement, and monitor preventive and corrective actions to ensure that quality standards are achieved.

• Generates monthly reports of audit findings, supports clients with issues identified and develops reports to assist

management with information requested.

• Produces other ad hoc reports as requested by internal and external clients. Associates at this level conduct routine to

complex audits, generally related to one or more functions on one or more systems platform for one or more lines of

business

Active PHRN/USRN License

At least 1 year QA experience in Coding.

At least

1 year

DRG Coding experience.

One or more of the following certifications:

Certified Documentation Improvement Practitioner (CDIP

Certified Professional Coder (CPC)

Inpatient Coding Credential such as CCS (AHIMA)

Inpatient Coding Credential such as CIC (AAPC)

RHIT or RHIA (preferred Certification) for US only

Certified Clinical Documentation Specialist (CCDS)