OP Coding Validator I

Beth Israel Lahey Health; United States; On-site; USD 40,000 - 64,000; Full time

Job summary

Beth Israel Lahey Health is seeking a Coding Validator I to join our growing team. Under the Director of Coding, you will perform quality reviews of inpatient records to validate ICD-10-CM/PCS, CPT, DRG or APC appropriateness, identify missed diagnoses, and support accurate reimbursement.

You will collaborate with the HIM team to ensure coding uniformity, provide feedback to staff, and participate in system testing of 3M coding software and the EHR.

Qualifications

• Education: Associate degree in Health Information Management or AHIMA/AAPC certification required.
• Licensure/Certification: RHIA, RHIT, or CCS; CIC from AAPC required.
• Experience: Minimum 3 years inpatient ICD-10-CM/ICD-10-PCS coding.
• Skills: medical terminology, MS Office, knowledge of ICD-10 guidelines, strong written communication, and EHR knowledge.

Responsibilities

• Performs pre-bill inpatient audits to ensure compliant coding and payer interpretation.
• Provides educational feedback on coding and reimbursement changes.
• Performs Patient Safety Indicators and Hospital-Acquired Condition reviews.
• Performs focused DRG audits and supports coding accuracy.
• Writes compliant retro coding queries to providers when indicated.
• Collaborates with CDIS and clinical staff to improve processes.
• Tests systems related to 3M coding software and EHR.
• Attends meetings and pursues ongoing professional development.
• Serves as coding resource for other departments.

Skills

Medical terminology

Excel

Word

PowerPoint

ICD-10-CM

ICD-10-PCS

CPT coding

EHR systems

Written communication

Data management

Education

Associate degree in Health Information Management

AHIMA or AAPC coding certification

Tools

3M Coding Software

Electronic Health Record (EHR)

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 audits.
• Serves 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, required
• Licensure, Certification & Registration: RHIA, RHIT, or CCS from AHIMA or a CIC from AAPC, required
• Experience: Minimum 3 year of ICD-10-CM, ICD-10-PCS Inpatient coding assignment, required
• Required Skills, Knowledge & Abilities: Medical terminology Proficient in Microsoft Office Excel, Word, and PowerPoint applications Knowledge and understanding of current ICD-10-CM and ICD-10-PCS Official Guidelines for Coding and Reporting Knowledge of medical records content and management Strong written communication skills Working knowledge of the EHR either through experience or education, including experience working with structured data and database management Knowledge of laws and regulations about health information and patient confidentiality Adheres to Department, Hospital, and Human Resource Policies
• Preferred Qualifications & Skills: EHR experience 3M-360 Computer Assisted Coding Dept./Unit-Specific Skills: IP Validator 1 level ICD-10-CM, ICD-10-PCS Inpatient code assignment skills based on BILH IP Coding Validator Exam
• Key Business Relationships: Coding Director: Day to day direction, scheduling and support Medical Staff: Provide support, education and training Coding colleagues: Process improvement, knowledge sharing, quality of work, productivity and training and education External facilities: Work with hospitals, provider practices and vendors on requests related to Coding and Validation

Pay Range: $29.00 - $46.40 The 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/Disabled At Beth Israel Lahey Health, we are driving the change in health care that Massachusetts wants and needs. Our culture promotes continuous learning, growth, innovation and a sense of belonging. We make it a priority to offer comprehensive compensation and benefits and help you achieve a healthy and balanced life. While you're busy caring for and supporting our patients, we take care of you.