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Under the general supervision of the Director of Coding, 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 ensure the correct coding assignment.
The Coding Validator III works closely with the Director of Coding and Coding leadership to assure coding uniformity, consistency and accuracy ICD-10- CM, CPT, Official Coding Guidelines, Federal and State regulations, the American Medical Association or American Hospital Association coding guidelines.

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

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

• Microsoft Office applications

• 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

The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law.  Compensation may exceed the base hourly rate depending on shift differentials, call pay, premium pay, overtime pay, and other additional pay practices, as applicable to the position and in accordance with the law.

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) as a condition of employment. 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