IP Coding Validator III

Job Type: Regular

Time Type: Full time

Work Shift: Day (United States of America)

FLSA Status: Non-Exempt

When you join the growing BILH team, youre not just taking a job, you’re making a difference in people’s lives.

Under general supervision of the Director of Coding and Validation, the Coding Validator III is responsible for performing quality reviews on medical records to validate the ICD-10-CM and ICD-10-PCS codes, DRG appropriateness, missed secondary diagnoses and procedures, and ensure compliance and accuracy of the MS-DRG, APR DRG and HCPCS assignments. The Coding Validator III works closely with the Director of Coding and Validation, Coding & Reimbursement Coordinator and collaborates with Clinical Documentation Staff to assure coding uniformity, consistency and accuracy with ICD-10-CM, ICD-10-PCS, HCPCS coding guidelines, Official Coding Guidelines, Federal and State regulations, the American Hospital Association coding guidelines and its publication Coding Clinic and American Medical Associations publication CPT Assistant. The Coding Validator III is also responsible for coding functions to support timely coding and billing. The Coding Validator III is also responsible for exceeding quality and quantity expectations while performing coding functions to support timely coding and billing.

Job Description:

Essential Responsibilities:

1. Reviews inpatient and outpatient medical records pre-billing to determine if codes need to be added/deleted and to ensure that the care of the patient is recorded in language that the payers can interpret.

2. Responsible for coding all types of inpatient and outpatient medical records with efficiency and accuracy.

3. May Work closely with the HIM Clinical Documentation Improvement Specialist (CDIS) and clinical staff to evaluate inpatient coding and CDIS assignment; offers recommendations to redesign these processes in order to improve fiscal liability and quality of coded data.

4. Works with programmers to define specifications as well as test systems and applications related to the 3M coding software interface to CCC.

5. Reviews findings of third party coding audits. Prepares appeal letters to third part audit when deemed appropriate.

6. Provides appropriate orientation and ongoing in-service training/education for coding staff in coding, documentation, and reimbursement methodologies. Serves as a central resource for inpatient and ambulatory coding questions.

7. Provides appropriate educational feedback to coding staff related to coding and reimbursement changes utilizing the 3M HDM Audit Chapter.

8. Prepares coder question and answer documents to support coding accuracy and consistency.

9. Attends meetings and educational conferences, assuming personal responsibility for professional development and ongoing education to maintain proficiency.

10. Works on special projects and serves as a coding resource for other BIDMC departments. Completes Patient Safety Indicator reviews.

Required Qualifications:

1. High School diploma or GED required.

2. Certificate 1 Certified Coding Specialist required.

3. More than 10 years related work experience required.

4. Knowledge of ICD-10-CM, ICD-10-CM/PCS, and CPT-4 coding.

5. Knowledge of Medicare, Medicaid and third party coding requirements, including MS-DRGs, APR-DRGs and AP-DRGs.

6. Experience with computer systems required, including web based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access.

Competencies:

1. Decision Making: Ability to make decisions that are guided by precedents, policies and objectives. Regularly makes decisions and recommendations on issues affecting a department or functional area.

2. Problem Solving: Ability to address problems that are highly varied, complex and often non-recurring, requiring staff input, innovative, creative, and Lean diagnostic techniques to resolve issues.

3. Independence of Action: Ability to set goals and determines how to accomplish defined results with some guidelines. Manager/Director provides broad guidance and overall direction.

4. Written Communications: Ability to summarize and communicate in English moderately complex information in varied written formats to internal and external customers.

5. Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers.

6. Knowledge: Ability to demonstrate in-depth knowledge of concepts, practices and policies with the ability to use them in complex varied situations.

7. Team Work: Ability to act as a team leader for small projects or work groups, creating a collaborative and respectful team environment and improving workflows. Results may impact the operations of one or more departments.

8. Customer Service: Ability to provide a high level of customer service and staff training to meet customer service standards and expectations for the assigned unit(s). Resolves service issues in the assigned unit(s) in a timely and respectful manner.

Social/Environmental Requirements:

1. Work requires close attention to task for work to be accurately completed. Intermittent breaks during the work day do not compromise the work.

2. Work is varied every day and the employee needs to be adaptable to respond to these changes and use independent judgment and manage priorities.

3. No substantial exposure to adverse environmental conditions

4. Health Care Status: NHCW: No patient contact.- Health Care Worker Status may vary by department

Sensory Requirements:

Close work (paperwork, visual examination), Color vision/perception, Visual monotony, Visual clarity > 20 feet, Visual clarity <3 feet, Conversation, Monitoring Equipment, Telephone.

Physical Requirements:

Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally

This job requires frequent sitting, Power Grasping using one hand, Fine Manipulation using one hand.

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more (https://www.bilh.org/newsroom/bilh-to-require-covid-19-influenza-vaccines-for-all-clinicians-staff-by-oct-31) about this requirement.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients lives. Your skill and compassion can make us even stronger.

Equal Opportunity Employer/Veterans/Disabled