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

Job Type:

Regular

Scheduled Hours:

40

Work Shift:

Day (United States of America)

Job Summary: Under general supervision of the Director of Coding and Validation, the Coding Validator II is responsible for performing quality reviews on medical records to validate the ICD-10-CM and ICD-10-PCS codes, DRG appropriateness, missed secondary diagnoses and procedures, and ensure compliance and accuracy of the MS-DRG, APR DRG and HCPCS assignments. The Coding Validator II works closely with the Director of Coding and Validation, Coding & Reimbursement Coordinator and collaborates with Clinical Documentation Staff to assure coding uniformity, consistency and accuracy with ICD-10-CM, ICD-10-PCS, HCPCS coding guidelines, Official Coding Guidelines, Federal and State regulations, the American Hospital Association coding guidelines and its publication Coding Clinic and American Medical Association's publication CPT Assistant. 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 Responsibilities:

Reviews inpatient or outpatient medical records pre-billing to determine if codes need to be added/deleted and to insure that the care of the patient is recorded in language that the payers can interpret.

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

May work 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 in order 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 interface to CCC.

Reviews findings of third party coding audits. Prepares appeal letter content for inclusion in the appeal letter routed to the third party.

Provides appropriate educational feedback to coding staff related to coding and reimbursement changes utilizing the 3M HDM Audit Chapter. Serves as a central resource for inpatient or ambulatory coding questions.

Prepares coder question and answer documents to support coding accuracy and consistency.

Attends meetings and educational conferences, assuming personal responsibility for professional development and ongoing education to maintain proficiency.

Works on special projects and serves as a coding resource for other BIDMC departments.

Completes Patient Safety Indicator reviews.

Required Qualifications:

High School diploma or GED required.

Registration Registered Health Info Admin required., or Certificate 1 Registered Health Info Tech required., or Certificate 2 Certified Coding Specialist required.

3-5 years related work experience required.

Knowledge of ICD-10-CM, ICD-10-CM/PCS, and CPT-4 coding.

Knowledge of Medicare, Medicaid and third party coding requirements, including MS-DRGs, APR-DRGs and AP-DRGs.

Basic familiarity with computers. Ability to navigate at a basic level within web-based applications.

Preferred Qualifications:

Working knowledge of Microsoft Office Applications.

Competencies:

Decision Making: Ability to make decisions that are guided by precedents, policies and objectives. Regularly makes decisions and recommendations on issues affecting a department or functional area.

Problem Solving: Ability to address problems that are highly varied, complex and often non-recurring, requiring staff input, innovative, creative, and Lean diagnostic techniques to resolve issues.

Independence of Action: Ability to set goals and determines how to accomplish defined results with some guidelines. Manager/Director provides broad guidance and overall direction.

Written Communications: Ability to summarize and communicate in English moderately complex information in varied written formats to internal and external customers.

Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers.

Knowledge: Ability to demonstrate in-depth knowledge of concepts, practices and policies with the ability to use them in complex varied situations.

Team Work: Ability to act as a team leader for small projects or work groups, creating a collaborative and respectful team environment and improving workflows. Results may impact the operations of one or more departments.

Customer Service: Ability to provide a high level of customer service and staff training to meet customer service standards and expectations for the assigned unit(s). Resolves service issues in the assigned unit(s) in a timely and respectful manner.

Physical Nature of the Job:

Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally

FLSA Status:

Non-Exempt

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 (https://www.bilh.org/newsroom/bilh-to-require-covid-19-influenza-vaccines-for-all-clinicians-staff-by-oct-31) 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