Coding Validator Telecommute IP - Brown University Health : Job Details

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 to validate ICD-10-CM codes, DRG group appropriateness, missed secondary diagnoses and procedures, and ensures compliance with all DRG mandates and reporting requirements. Ensures data validity prior to bill submission. Performs retrospective coding audits as required.Performs data quality reviews on outpatient encounters to validate ICD-10-CM, CPT, and HPCS Level II codes, modifier assignments, APC group appropriateness, missed secondary diagnoses and procedures, ensuring compliance with outpatient coding mandates. Ensures medical necessity criteria are met and local medical review policies are followed.Continuously evaluates the quality of clinical documentation to identify incomplete or inconsistent documentation affecting code selection, DRG groups, and payments. Raises concerns with the department manager for resolution.Provides training for coding staff and educates healthcare professionals on coding guidelines, proper documentation, medical terminology, disease processes, and clinical data quality management. Maintains current knowledge of professional coding certification requirements.Reviews coding validator error queues and CED work queues, identifies coding or charge issues, and reports findings to leadership. Performs routine validation audits and prepares accuracy reports for the director.Adheres to the Standards of Ethical Coding set by AHIMA, monitors staff compliance, and reports violations to the Coding Manager.Provides guidance to coding staff in the absence of management.Other information: Basic Knowledge: Associate degree in health information technology (preferably RHIT) or successful completion of a coding certification program. Understanding of medical record content, trained in medical terminology, disease processes, anatomy, and physiology. Ability to recognize and interpret clinical documentation relevant for coding. Good writing skills for physician queries. Computer literacy, research skills, and ability to navigate electronic medical records. Coding certification required.Experience: Five years of coding optimization experience in an acute care setting. Past auditing or training experience in coding preferred.Working Conditions and Physical Requirements: Post-orientation, work is performed remotely at the employee's residence per telecommuting agreement. On-site requirements include meetings and other activities as determined by management.Independent Action: Works independently within department policies, consulting supervisor for complex issues requiring clarification.Supervisory Responsibility: None.Brown University Health is an Equal Opportunity employer and a VEVRAA Federal Contractor.Location: Brown University Health Corporate Services, Providence, RIWork Type: Per DiemShift: Shift 4Union: Non-Union#J-18808-Ljbffr