Coding Validator Telecommute IP- per diem

Massachusetts Health Information Management Association; Rhode Island; On-site; USD 60,000 - 90,000; Full time

Job summary

A leading healthcare organization in Rhode Island seeks a dedicated Coding Specialist to ensure accurate coding and data quality across inpatient and outpatient services. This role involves conducting coding audits, training staff, and maintaining compliance with medical documentation standards. Ideal candidates will have a strong coding background, attention to detail, and exemplary communication skills. Join us in improving healthcare delivery through precise coding practices.

Qualifications

• Understanding of medical record content and coding guidelines needed.
• Five years coding optimization experience in an acute care facility.
• Strong writing skills to prepare compliant physician queries.

Responsibilities

• Perform coding quality reviews on inpatient and outpatient records.
• Provide training for coding staff and educate healthcare professionals.
• Ensure compliance with coding guidelines and standards.

Skills

Medical Terminology

Attention to Detail

Clinical Documentation

Education

Successful completion of 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:

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 submission of bill. Performs retrospective coding audits as required.

Performs data quality reviews on outpatient encounters to validate the ICD-10-CM CPT and HPCS Level II codes modifier assignments APC group appropriateness missed secondary diagnosis and procedures and ensure compliance with all outpatient coding mandates. Ensures medical necessity criteria is met and local medical review polices are followed.

Continuously evaluates the quality of the clinical documentation to spot incomplete or inconsistent documentation for inpatient encounters that impact code selection and resulting DRG groups and payments. Brings identified concerns to department manager for resolution.

Provides training for coding staff and educates facility healthcare professionals in the use of coding guidelines and practices proper documentation techniques medical terminology and disease processes as it relates to the MS DRG APR DRG and/or outpatient APC and other clinical data quality management. Maintains knowledge of current professional coding certification requirements.

Reviews LifeChart coding validator coding error and CED work queues. Identifies any coding or coding related charge issues to leadership. Performs routine coding validation audits. Prepares reports for director on coder
accuracy results.

Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and monitors coding staff for violations and reports to Coding Manager when areas of concern are
identified. Provides direction to coding staff in absence of management.

BASIC KNOWLEDGE:

Successful completion of coding certification program. Understanding of the content of the medical record. Trained in medical terminology medical science disease processes anatomy and physiology. Ability to recognize and understand clinical documentation pertinent for coding. Good writing skills to prepare compliant physician queries. Computer literate; capable of researching websites to access regulatory requirements. Ability to navigate the patient electronic medical record. Coding specialist
certification required.

EXPERIENCE:

Five years coding optimization experience in an acute care facility. Past auditing experience or
strong training background in coding preferred.

Performs independently within the department�s policies and procedures. Refers specific complex problems to the supervisor when clarification of the departmental policies and procedures are required.