Coding Validator Telecommute IP

Job summary:

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 tovalidate the ICD-10-CM codes DRG group appropriateness missed secondarydiagnoses 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 reviewpolices 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 codingstaff 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.