Coding Validator Telecommute

Brown University Health; Providence (RI); Remote; USD 60,000 - 75,000; Full time

Job summary

A leading healthcare institution is seeking a Coding Validator for a telecommute role. The position involves auditing medical records, ensuring coding accuracy, and collaborating with various teams to enhance documentation practices. Candidates should have a strong coding background and knowledge of medical terminology. This role supports the organization's compliance and revenue integrity efforts.

Qualifications

• Minimum of five years coding experience, preferably in a large academic setting.
• Auditing experience or strong coding background preferred.

Responsibilities

• Audit professional ambulatory medical records to ensure billed codes are supported by documentation.
• Collaborate with Practices/Clinics, Providers, Coding Team, Compliance, and Payers.
• Identify coding/documentation trends that pose risks to the organization.

Skills

Knowledge of medical records

Good writing skills

Computer proficiency

Education

Associate degree or coding certification

Job description

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Summary
Reports to PFS Manager responsible for audit and education. Performs coder and provider audits of ICD-10 codes, CPT codes, HCPCS codes, and HCCs. Prepares training materials and provides education as needed. Stays updated on industry and payer changes related to coding and documentation guidelines.

Responsibilities
Audit professional ambulatory medical records (inpatient visits, outpatient visits, medication administration, surgeries, and office/clinic procedures) to ensure billed codes are supported by documentation.
Possess knowledge of teaching physician regulations including incident to, split/shared visits, and attestation requirements.
Review diagnoses, procedures, and modifiers assigned by coders; record outcomes. Share audit results with Validation Team Leadership for feedback to coders.
Review diagnoses and procedures assigned by providers; record outcomes. Share results with provider leadership.
Review medical records for hierarchal condition coding (HCCs) prior to patient visits to identify chronic conditions for assessment.
Stay informed about coding, documentation, compliance policies, industry updates, and payer policies. Apply this knowledge daily.
Identify coding/documentation trends that pose risks to the organization or revenue; report and suggest improvements to documentation templates in Epic.
Collaborate with Practices/Clinics, Providers, Coding Team, Compliance, Risk Management, Contracting, and Payers to ensure consistency and accuracy.
Adhere to the Standards of Ethical Coding as set by AAPC and AHIMA.

Other Information
Basic Knowledge: Associate degree or successful completion of a coding certification program. Knowledge of medical records, terminology, anatomy, physiology. Good writing skills. Computer proficiency, including research and navigating electronic health records.
Experience: Minimum of five years coding experience, preferably in a large academic setting. Auditing experience or a strong coding background preferred.
Working Conditions: Normal office environment.
Independence: Performs tasks independently within departmental policies; escalates complex issues.
Supervisory Responsibility: None.

Brown University Health is an Equal Opportunity Employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, age, ethnicity, sexual orientation, gender identity/expression, disability, veteran status, or marital status. Brown is a VEVRAA Federal Contractor.