Open position

Job Type: Regular

Time Type: Full time

Work Shift: Day (United States of America)

FLSA Status: Non-Exempt

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.

Under general supervision of the Director of Coding and Validation, the Coding Validator III is responsible for performing quality reviews on medical records to validate the assignment of ICD-10-CM, CPT, HCPC, and modifiers to assure the
correct APC assignment and other imbursement impacting elements.

The Coding Validator III works closely with the Director of Coding and Validation and Coding leadership to assure coding uniformity, consistency and accuracy ICD-10-CM, 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 II is also responsible for exceeding quality and quantity expectations while performing coding functions to support timely coding and billing

Job Description:

Essential Duties & Responsibilities:

• Performs pre-bill reimbursement audits on outpatient 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 Outpatient only and unlisted CPT/HCPC reviews.

• Performs Claim edit and Denial reviews

• Performs monthly post-bill coding audits

• Performs focused CPT/APC audits

• Performs data and analysis of coding quality data to identified coding error trends.

• Reviews findings of third-party coding audits.

• Prepares appeal letters to third party audit when deemed appropriate.

• Provides appropriate orientation and ongoing in-service training/education for coding staff in coding, documentation, and reimbursement methodologies.

• Serves as a central resource for outpatient coding questions.

• Prepares and presents monthly focused education for the coding department

• Prepares coding resource documents to support coding accuracy and consistency.

• Responsible for coding all types of outpatient medical records with efficiency and accuracy.

• Responsible for writing compliant retro coding queries to providers when indicated.

• Works with programmers to define specifications as well as test systems and applications related to the 3M coding software and Epic.

• 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:

• High School diploma or equivalent, required

• Minimum of Associate degree in Health Information Management or Completion of a AHIMA or AAPC Coding Certification program, required

Licensure, Certification & Registration:

• RHIA, RHIT or CCS from AHIMA or a COC from AAPC, required

Experience:

• Computer skills

• Minimum 5 year of ICD-10-CM, CPT/HCPC Outpatient coding assignment, required

• Minimum 1 year of ICD-10-CM, CPT/HCPC outpatient coding assignment at a Level 1 trauma or Academic Medical Center, preferred

• Minimum of 5 years OP coding auditing and/or OP coding validation, preferred • Microsoft Office applications

• Interventional Radiology, Cardiac Cath, Injection and Infusion, Observation, and Ambulatory Surgery coding experience, 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 CPT/HCPC Official Guidelines for Coding and Reporting

• Knowledge of medical records content and management

• Strong written communication skills

• Working knowledge of the EMR 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:

• Epic experience

• 3M-360 Computer Assisted Coding Dept

• OP Validator III level ICD-10-CM, CPT Outpatient code assignment skills based on BILH OP Coding Validator Exam

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) and COVID-19 as a condition of employment. Learn more about this requirement.

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