Coding Validator III
Department Description: The Health Information Management (HIM) Department of Beth Israel Deaconess Medical Center offers flexible hours, the ability to work from home or onsite, and the panache of working for a world class medical institution with an interesting and challenging case mix. Our department offers diverse professional opportunities by interacting and supporting clinical area operations, supporting ongoing training and development of our coding staff, and by our commitment to a work/life approach to business.
Job Location: Boston, MA
Req ID: 35333BR
Job Summary: 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 Association's 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.
- 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.
- Responsible for coding all types of inpatient and outpatient medical records with efficiency and accuracy.
- 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.
- Works with programmers to define specifications as well as test systems and applications related to the 3M coding software interface to CCC.
- Reviews findings of third party coding audits. Prepares appeal letters to third part 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 inpatient and ambulatory coding questions.
- Provides appropriate educational feedback to coding staff related to coding and reimbursement changes utilizing the 3M HDM Audit Chapter.
- Prepares coder question and answer documents to support coding accuracy and consistency.
- Attends meetings and educational conferences, assuming personal responsibility for professional development and ongoing education to maintain proficiency.
- Works on special projects and serves as a coding resource for other BIDMC departments. Completes Patient Safety Indicator reviews.
- High School diploma or GED required.
- Certificate 1 Certified Coding Specialist required.
- More than 10 years related work experience required.
- Knowledge of ICD-10-CM, ICD-10-CM/PCS, and CPT-4 coding.
- Knowledge of Medicare, Medicaid and third party coding requirements, including MS-DRGs, APR-DRGs and AP-DRGs.
- Experience with computer systems required, including web based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access.
- 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.
- 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.
- 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.
- Written Communications: Ability to summarize and communicate in English moderately complex information in varied written formats to internal and external customers.
- Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers.
- Knowledge: Ability to demonstrate in-depth knowledge of concepts, practices and policies with the ability to use them in complex varied situations.
- 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.
- 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.
Physical Nature of the Job:
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.
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