OP Coding Validator I

Beth Israel Lahey Health; Boston (MA); On-site; USD 40,000 - 64,000; Full time

Job summary

Beth Israel Lahey Health is seeking a Coding Validator I to perform quality reviews of inpatient records and validate ICD-10-CM/PCS, CPT, DRG or APC codes for accuracy and compliance. Under supervision of the Director of Coding, you will conduct pre-bill reimbursement audits, provide educational feedback, and collaborate with the HIM/CDIS teams to improve coding quality and fiscal outcomes.

You will work with EHR systems and 3M CAC tools, attend meetings, and participate in coding-related

Qualifications

• Proficient in medical terminology and coding guidelines.
• Experience with ICD-10-CM/ICD-10-PCS in inpatient coding.
• Familiarity with EHR systems and structured data.
• Knowledge of HIPAA and patient confidentiality requirements.
• Ability to write clear, compliant retro coding queries.
• Proficient in MS Office (Excel, Word, PowerPoint).
• Strong communication and teamwork skills.

Responsibilities

• Performs pre-bill reimbursement audits to ensure accurate coding.
• Provides educational feedback to staff on coding and reimbursement changes.
• Performs Patient Safety Indicators and Hospital-Acquired Condition reviews.
• Conducts focused DRG audits and answers inpatient coding questions.
• Collaborates with HIM CDIS and clinical staff to improve processes.
• Works with EHR and 3M CAC tools; tests system specifications.
• Attends meetings and participates in coding projects to support timely billing.

Skills

Medical terminology

Microsoft Office (Excel, Word, PowerP

Strong written communication

EHR knowledge

HIPAA / patient confidentiality

ICD-10-CM/ICD-10-PCS knowledge

Coding quality and accuracy

Education

Associate degree in Health Information Management

AHIMA or AAPC Coding Certification

RHIA/RHIT/CCS or CIC certification

Tools

3M-360 Computer Assisted Coding

Job description

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.Under the general supervision of the Director of Coding, the Coding Validator I is responsible for performing quality reviews on medical records to validate the ICD-10-CM, ICD-10-PCS codes or CPT, DRG or APC appropriateness, missed secondary diagnoses and procedures, and ensure compliance and accuracy of the APC and other reimbursement impacting elements. The Coding Validator I works closely with the Director of Coding and Coding leadership to ensure coding uniformity, consistency, and accuracy with ICD-10-CM, ICD-10-PCS, CPT, Official Coding Guidelines, Federal and State regulations, the American Hospital Association coding guidelines and its publication Coding Clinic. The Coding Validator I is also responsible for coding functions to support timely coding and billing. The Coding Validator I is also responsible for exceeding quality and quantity expectations while performing coding functions to support timely coding and billing.Job Description:Essential Duties & Responsibilities including but not limited to:Performs pre-bill reimbursement audits on inpatient records to determine if codes need to be added/deleted, to ensure that the care of the patient is recorded in language that the payers can interpret, and coding is compliant with all coding guidelines.Provides appropriate educational feedback to coding staff related to coding and reimbursement changes.Performs Patient Safety Indicators and Hospital-Acquired Condition reviews.Performs focused DRG auditsServes as a central resource for inpatient coding questions.Responsible for coding all types of inpatient medical records with efficiency and accuracy.Responsible for writing compliant retro coding queries to providers when indicated.Works 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 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 and Electronic Health Record (EHR).Attends meetings and educational conferences, assuming personal responsibility for professional development and ongoing education to maintain proficiency.Works on special coding-related projects and serves as a coding resource for other BILH departments.Minimum Qualifications:Education:Minimum of an Associate degree in Health Information Management or Completion of an AHIMA or AAPC Coding Certification program, requiredLicensure, Certification & Registration:RHIA, RHIT, or CCS from AHIMA or a CIC from AAPC, requiredExperience:Minimum 3 year of ICD-10-CM, ICD-10-PCS Inpatient coding assignment, requiredRequired Skills, Knowledge & Abilities:Medical terminologyProficient in Microsoft Office Excel, Word, and PowerPoint applicationsKnowledge and understanding of current ICD-10-CM and ICD-10-PCS Official Guidelines for Coding and ReportingKnowledge of medical records content and managementStrong written communication skillsWorking knowledge of the EHR either through experience or education, including experience working with structured data and database managementKnowledge of laws and regulations about health information and patient confidentialityAdheres to Department, Hospital, and Human Resource PoliciesPreferred Qualifications & Skills:EHR experience3M-360 Computer Assisted CodingDept./Unit-Specific Skills:IP Validator 1 level ICD-10-CM, ICD-10-PCS Inpatient code assignment skills based on BILH IP Coding Validator ExamKey Business Relationships:Coding Director: Day to day direction, scheduling and supportMedical Staff: Provide support, education and trainingCoding colleagues: Process improvement, knowledge sharing, quality of work, productivity and training and educationExternal facilities: Work with hospitals, provider practices and vendors on requests related to Coding and ValidationPay Range:$29.00 – $46.40The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law. Compensation may exceed the base hourly rate depending on shift differentials, call pay, premium pay, overtime pay, and other additional pay practices, as applicable to the position and in accordance with the law.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) as a condition of employment.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/DisabledEmployment: Full-timeHours/Week: 40Shift: DayCategory: Coding/ValidationPay Range: $29.00 - $46.40FLSA: Non-ExemptReq ID: JR105928