Coding Validator - 40 hoursweek days

Under the general direction of the Coding Manager the DRG/Coding Validator performs quality reviews of records coded by the coding staff to validate the ICD9CM CPT and DRG assignment to ensure consistency and efficiency in inpatient and outpatient claims processing and data collection for the hospital. Report findings to the Coding Manager and assists with the development of process improvements to maintain data quality.Provide ongoing educational support to coding staff clinical documentation specialists physicians and other clinicians to assure appropriate assignment of ICD9CM ICD9PCS CPT and DRG assignment according to hospital and applicable coding guidelines.Perform data quality reviews and focused audits on Inpatient records to validate the ICD9CM ICD9PCS DRG assignment. Focus on principal diagnosis selection and also identify missed secondary diagnosis which impact patient severity. Ensures compliance with all DRG mandates official coding guidelines and reporting requirements.Perform data quality reviews and focused audits on Outpatient records to validate the ICD9CM ICD9PCS CPT codes modifier usage and ensures compliance with coding guidelines medical necessity and reporting requirements.ICD10 knowledge to identify documentation impacts concerning Inpatient and Outpatient coding.Responisible for overseeing the training process to ensure the appropriate training steps are in place and followed through.Responsible for sending out weekly communication internally on the areas of validation for the weekIdentification of coding trends areas of opportunity internally and externallyMonitor Medicare and other DRG/Coding paid bulletins and manuals. Communicates updates published in thirdparty payer newsletters and bulletins and provider manuals to all facility staff that need this information.Review current OIG work plans for inpatient and outpatient coding and DRG and CPT risk areas.Continuously evaluates the quality of clinical documentation to spot incomplete or inconsistent documentation for inpatient and outpatient encounters that impact the code selection and resulting CPT code and DRG assignment and payment. Reviews identified concerns with the Coding Managers.Evaluates records and responds to the PRO DRG changes RAC Audits Blue Cross Audits Medical Necessity denials Medicare CCI edits and all other pertinent denial notices. Reviews with Coding Managers prepares appeal letters identifying appropriate documentation and references when appropriate.Act as administrative and clinical educator/trainer resource person for the dissemination of DRG interpretation and Coding information departmentally in conjunction with the Coding Manager. Maintains and creates accurate policies and procedures to support educational process.Acts as a contact person for the concurrent review process conducted by the Clincal Documentation Improvement specialist for coding questions DRG assignments and provides education for coding /DRG changes found in the random/ focused review and quarterly coding changes in conjunction with the Coding Managers.Active participation in service line meetings within the coding departmentLiaison between Revenue Cycle Departments (Patient Accounts Patient Access Charge Capture Compliance) Case Management Clinical areas and Coding to research and resolve coding/billing issues.Knowledge of Hospital Acquired Conditions Signficant Reportable Events and Patient Safety Indicators and the impact coding has on quality reportingKnowledge of 3m resources such as AHA Coding Clinic AMA CPT Assistannt AHA Coding Clinic for HCPCSPerforms Quality Assurance audits on all Inpatient and Outpatient coders in conjunction with the department QA program and coding managers.Assists the Coding Manager to implement new systems policies and procedures in the Coding area.Serves as the facility representative by attending coding and reimbursement workshops and brings back information to the appropriate department.Demonstrates competency in the use of computer applications and DRG Grouper software 3M Encoder Lynx Medicare edits and all coding and abstracting software currently in use in the Health Information Management department.Reviews and references available resource material on a continuous basis.Recognizes and understands the role of a coder in the department and how it relates to the overall function of the hospital regarding patient care casemix and fiscal reimbursement.Promotes public relations through prompt and courteous service. Assists external departments in orientating students from other healthcare related programs about the CDI/Coding department.Fosters respect for privacy by maintaining confidentiality in all phases of the work.Attends all coding DRG and CDI meetings as needed. Responsible to perform any and all other assigned duties as requested. SkillsRequired: Possess indepth knowledge of coding/classification systems appropriate for inpatient outpatient and DRG prospective payment system. Computer literate; knowledge of Microsoft Office 3M software. Knowledge of health information systems and data management. Knowledge of health record content and sequence. Knowledge of JCAHO requirements federal and state guidelines applicable to health record completeness and patient privacy. Must be able to process and provide accurate paperwork. Must be able to meet deadlines. Strong analytical skills detailoriented. Able to work independently as well as a teammember. Responsible for professional development and continuous education to maintain proficiency. Ability to accept constructive analysis based on feedback from inside/outside auditors and quality improvement initiatives. Ability to maintain confidentiality with regard to all phases of the work. Extensive use of computer and office equipment including fax copy machine readers/printers. ExperienceRequired: 35 years of coding experiencePreferred: Minimum of 5 years progressive coding experience and or coding review experience in ICD9CM with claims processing and data management responsibility.EducationRequired: Bachelors Degree preferred in business finance a healthcare discipline or equivalent experience.Licensure Certification RegistrationRequired: AHIMA credential Registered Health information technician (RHIT) Registered Health Information Administrator (RHIA) and/or Certified Coding Specialist (CCS) Certified Coding SpecialistProfessional (CCSP).