Lead Coding Validator Telecommute

SUMMARY

Performs coder and provider audits of ICD-10 codes, CPT codes, HCPCS codes and HCC’s. Prepares training materials and provides education as needed. Stays abreast of industry and payer changes pertaining to coding and documentation guidelines.

PRINCIPAL DUTIES AND RESPONSIBILITIES

Brown University Health employees are expected to successfully role model the organization’s values of Compassion, Accountability, Respect, and Excellence as these guide our everyday actions with patients, customers and one another.

• Audit professional ambulatory medical records (inpatient visits, outpatient visits, medication administration, surgeries and office/clinic procedures) to ensure billed codes are accurately supported by the documentation.
• Possess knowledge of teaching physician regulations, including incident to, split shared and attestation requirements.
• Review diagnoses, procedures and modifiers assigned by coders, and record outcomes. Share completed audit results with Validation Team Leadership who will relay results to Coding Manager and/or Director so they can provide feedback to the individual coders, as needed.
• Review diagnoses and procedures assigned by providers and record outcomes. Share completed audit results with Validation Team Leadership who will relay results to individual providers and provider leadership.
• Review medical records for hierarchal condition coding (HCC’s) in advance of patient visits to identify chronic conditions that the provider may want to assess.
• Stay abreast of coding and documentation guidelines, compliance policies, annual coding updates, payer policies and industry changes. Utilize this knowledge in day to day workload.
• Identify coding/documentation trends that may pose a risk to Brown University Health or its revenue stream and report such trends to management team. Recommend improvements to documentation templates in Epic that will minimize compliance risk and facilitate accurate documentation for the providers. Assure documentation is defensible in the event of an external audit.
• Work with Practices/Clinics, Providers, Coding Team, Corporate Compliance, Risk Management, Contracting and Payers to help assure that all departments are consistently on the same page and able to provide accurate feedback to coders and providers.
• Abide by the Standards of Ethical Coding as set forth by the American Academy of Professional Coders and American Health Information Management Association.
• Perform other duties as assigned.

EDUCATION

• Associate degree and/or successful completion of coding certification program.
• Understanding of the content of the medical record.
• Trained in medical terminology, medical science, anatomy and physiology.

EXPERIENCE

• Five years coding experience, preferable in a large, academic practice/facility. Past auditing experience or strong background in coding preferred.
• Ability to recognize and understand clinical documentation pertinent for coding.
• Good writing skills to communicate coding/documentation issues clearly.
• Computer literate; capable of researching websites to access regulatory requirements.
• Ability to navigate the patient electronic medical record.

WORKING CONDITION AND PHYSICAL REQUIREMENTS

Normal office environment.

INDEPENDENT ACTION

Performs independently within the department’s policies and procedures. Refers specific complex problems to the manager when clarification of the departmental policies and procedures are required.

SUPERVISORY RESPONSIBILITY

Leads and coordinates the daily work of assigned staff, providing direction, training, and support as needed.

Pay Range

$67,724.80-$111,716.80

Location

Corporate Headquarters - 15 LaSalle Square Providence, Rhode Island 02903

Work Type

M-F 8:00 AM to 4:30 PM

Work Shift

Day

Daily Hours

8 hours

Driving Required

No

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.