Coding Validator 3 (Remote)

Beth Israel Lahey Health

2d•$31 - $50•Remote

About The Position

Under the general supervision of the Director of Coding, the Coding Validator III is responsible for performing quality reviews on medical records to validate the assignment of ICD-10-CM, CPT, HCPC, and modifiers to ensure the correct coding assignment. The Coding Validator III works closely with the Director of Coding and Coding leadership to assure coding uniformity, consistency and accuracy ICD-10- CM, CPT, Official Coding Guidelines, Federal and State regulations, the American Medical Association or American Hospital Association coding guidelines.

Requirements

High School diploma or equivalent, required
Minimum of Associate degree in Health Information Management or Completion of a AHIMA or AAPC Coding Certification program, required
CPC from AAPC, required
Minimum 5 year of ICD-10-CM, CPT/HCPC coding assignment, required
Minimum of 5 years coding auditing and/or coding validation, preferred
Microsoft Office applications
Primary Care, E/M coding for surgical and medical specialties, audting experience, required
Computer Skills
Medical terminology
Proficient in Microsoft Office Excel, Word and PowerPoint applications
Knowledge and understanding of current ICD-10-CM and CPT/HCPC Official Guidelines for Coding and Reporting
Knowledge of medical records content and management
Strong written communication skills
Working knowledge of the EMR either through experience or education, including experience working with structured data and database management
Knowledge of laws and regulations about health information and patient confidentiality
Adheres to Department, Hospital, and Human Resource Policies

Nice To Haves

Epic experience
Level III PB Coding experience/Auditing experience

Responsibilities

Performs audits on PB coded records to determine if codes need to be added/deleted, to ensure that the care of the patient is recorded in language that the payers can interpret, and coding is compliant with all coding guidelines.
Provides appropriate educational feedback to coding staff related to coding and reimbursement changes.
Performs audit on PB Inpatient coded data.
Performs Claim edit and Denial reviews
Performs monthly post-bill coding audits
Performs focused payer audits
Performs data and analysis of coding quality data to identify coding error trends.
Reviews findings of third-party coding audits.
Prepares appeal letters to third party audit when deemed appropriate.
Provides appropriate orientation and ongoing in-service training/education for coding staff in coding, documentation, and reimbursement methodologies.
Serves as a central resource for coding questions.
Prepares and presents monthly focused education for the coding department
Prepares coding resource documents to support coding accuracy and consistency.
Responsible for coding all types of outpatient medical records with efficiency and accuracy.
Responsible for writing compliant retro coding queries to providers when indicated.
Attends meetings and educational conferences, assuming personal responsibility for professional development and ongoing education to maintain proficiency.
Works on special coding related projects and serves as a coding resource for other BILH departments.