Coding Validator 3 (Remote)

Job Description

Essential Duties & Responsibilities:

• Performs audits on PB coded 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 audit on PB Inpatient coded data.
• Performs Claim edit and Denial reviews.
• Performs monthly post-bill coding audits.
• Performs focused payer audits.
• Performs data and analysis of coding quality data to identify 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 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.
• 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
• Licensure, Certification & Registration: CPC from AAPC, required
• Experience: Minimum 5 year of ICD-10-CM, CPT/HCPC coding assignment, required; Minimum of 5 years coding auditing and/or coding validation, preferred
• Experience: Primary Care, E/M coding for surgical and medical specialties, audting experience, required

Required Skills, Knowledge & Abilities

• Computer Skills
• 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
• Level III PB Coding experience/Auditing experience

Pay Range

$31.37 – $50.20