Coding Validator Telecommute IP

Massachusetts Health Information Management Association; Rhode Island; On-site; USD 70,000 - 85,000; Full time

Job summary

A leading healthcare organization in Rhode Island is seeking a coding quality reviewer responsible for ensuring accurate coding and data quality. The role involves validating codes for inpatient and outpatient services while providing education and training to staff. Ideal candidates will have a coding specialist certification and at least five years of coding experience in an acute care facility.

Qualifications

• Five years of coding optimization experience in an acute care facility.
• Successful completion of a coding certification program.

Responsibilities

• Perform coding quality reviews on inpatient records to validate ICD-10-CM codes.
• Provide training for coding staff on guidelines and documentation techniques.
• Continuously evaluate the quality of clinical documentation.

Skills

Computer literacy

Strong writing skills

Understanding of medical terminology

Ability to recognize clinical documentation

Education

Coding specialist certification

Completion of a coding certification program

Job description

Ensures accurate coding and data quality, creating consistency and efficiency in inpatient and/or outpatient services through ongoing performance of ICD-10-CM and/or CPT coding validation and accurate MS-DRG, APR-DRG, and/or outpatient APC.

Responsibilities:

1. Performs coding quality reviews on inpatient records to validate the ICD-10-CM codes, DRG group appropriateness, missed secondary diagnoses and procedures, and ensures compliance with all DRG mandates and reporting requirements. Ensures validity of data prior to submission of bills. Performs retrospective coding audits as required.
2. Performs data quality reviews on outpatient encounters to validate the ICD-10-CM, CPT, and HCPCS Level II codes, modifier assignments, APC group appropriateness, missed secondary diagnoses and procedures, and ensures compliance with all outpatient coding mandates. Ensures medical necessity criteria are met and local medical review policies are followed.
3. Continuously evaluates the quality of clinical documentation to identify incomplete or inconsistent documentation for inpatient encounters that impact code selection, DRG groups, and payments. Reports concerns to the department manager for resolution.
4. Provides training for coding staff and educates healthcare professionals on coding guidelines, proper documentation techniques, medical terminology, and disease processes related to MS-DRG, APR-DRG, outpatient APC, and other clinical data quality management. Maintains knowledge of current professional coding certification requirements.
5. Reviews coding validator queues, identifies coding or charge issues, and reports findings to leadership. Performs routine validation audits and prepares reports on coder accuracy results for the director.
6. Adheres to the Standards of Ethical Coding set by the American Health Information Management Association (AHIMA) and monitors coding staff for violations, reporting concerns to the Coding Manager. Provides direction in the absence of management.

Basic Knowledge:

• Successful completion of a coding certification program.
• Understanding of medical record content, medical terminology, disease processes, anatomy, and physiology.
• Ability to recognize and understand clinical documentation relevant to coding.
• Strong writing skills for compliant physician queries.
• Computer literacy, including researching regulatory requirements online and navigating electronic medical records.
• Coding specialist certification required.

Experience:

• Minimum of five years of coding optimization experience in an acute care facility.
• Previous auditing experience or strong training background in coding preferred.

Performs independently within departmental policies and procedures, referring complex issues to the supervisor when clarification is needed.