Coding Educator - Validator

Cape Cod Healthcare•Hyannis, MA

About The Position

This role involves performing inpatient and outpatient medical record audits to validate diagnoses and procedures according to coding guidelines and insurance regulations. The Coding Educator - Validator will also provide education and guidance to coders and other hospital staff on coding best practices, new guidelines, and billing regulations. This position requires developing training materials, assessing physician documentation for coding strategies, and assisting with third-party audit findings and appeals. The role also includes providing coding support to various departments and maintaining up-to-date knowledge of all coding and reimbursement rules.

Requirements

Minimum of 5 years inpatient coding experience in an acute care facility required.
AHIMA CCS credential and AHIMA approved ICD-10 Trainer required.
Must possess excellent communication skills.
Working knowledge of Microsoft Word and Microsoft Excel required.

Nice To Haves

AHIMA RHIT or RHIA preferred.
Experience performing outpatient coding preferred.
Siemens Soarian and 3M experience preferred.

Responsibilities

Perform inpatient and outpatient medical record audits to validate appropriate diagnoses and procedures based on coding guidelines and insurance regulations.
Abide by AHIMA standards of Ethical Coding when performing validation reviews and provide feedback to Sr. Coding Manager of any potential compliance issues related to coding and physician documentation.
Provide guidance and education to Coders on validation findings to support compliant coding and increase knowledge and skills.
Conduct regular educational sessions with Coders (and other hospital staff as needed) on newly published coding guidelines or billing regulations to assure coding staff possess accurate information and follow new requirements.
Develop curriculum and training materials for staff learning ICD-9-CM / ICD-10-CM and CPT coding.
Revise and provide recommendations of best practice standards for coding policies and procedures.
Assess physician documentation and provide recommendations for coding strategies and physician queries that aim to improve hospital severity and mortality data. Will also provide regular education to Clinical Documentation Specialists (CDS) as needed.
Assist in review and assessment of audit findings from third parties that provide coding validation audits. Formulate and write appeals when appropriate and/or educate Coder(s) when required.
Provide coding support and answer coding questions for Patient Financial Services and other departments.
Maintain up-to-date working knowledge of all coding and reimbursement rules and regulations. Must be able to assign modifiers correctly and assist in working edits when necessary.
Stay current in all areas of coding and maintain continuing education units to remain credentialed.