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**Job Type:** Regular

**Time Type:** Full time

**Work Shift:** Day (United States of America)

**FLSA Status:** Non-Exempt

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

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 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 other reimbursement impacting elements. The Coding Validator III works closely with the Director of Coding and Validation and coding leadership and collaborates with Clinical Documentation Staff to ensure coding uniformity, consistency, and accuracy with ICD-10-CM, ICD-10-PCS, Official Coding Guidelines, Federal and State regulations, the American Hospital Association coding guidelines and its publication Coding Clinic. The Coding Validator III is also responsible for coding functions to support timely coding and billing. The Coding Validator III is also responsible for exceeding quality and quantity expectations while performing coding functions to support timely coding and billing.

Job Description:

**Essential Duties & Responsibilities** including but not limited to:

+ Performs pre-bill reimbursement audits on inpatient 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 Patient Safety Indicators and Hospital-Acquired Condition reviews.

+ Performs monthly post-bill coding audits

+ Performs focused DRG 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 inpatient coding questions.

+ Prepares coding resource documents to support coding accuracy and consistency.

+ Prepares and presents monthly focused education for the coding department and partners with CDI for joint department education bi-monthly.

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

+ Responsible for writing compliant retro coding queries to providers when indicated.

+ Works 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 and Electronic Health Record (EHR).

+ 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:

+ Minimum of an Associate degree in Health Information Management or Completion of an AHIMA or AAPC Coding Certification program, required

Licensure, Certification & Registration:

+ RHIA, RHIT, or CCS from AHIMA or a CIC from AAPC, required

Experience:

+ Minimum 5 year of ICD-10-CM, ICD-10-PCS Inpatient coding assignment, required

Required Skills, Knowledge & Abilities:

+ Medical terminology

+ Proficient in Microsoft Office Excel, Word, and PowerPoint applications

+ Knowledge and understanding of current ICD-10-CM and ICD-10-PCS Official Guidelines for Coding and Reporting

+ Knowledge of medical records content and management

+ Working knowledge of the EHR either through experience or education, including experience working with structured data and database management

+ Strong written communication skills

+ Knowledge of laws and regulations about health information and patient confidentiality

+ Adheres to Department, Hospital, and Human Resource Policies

Preferred Qualifications & Skills:

+ Minimum of 5 years IP coding auditing and/or IP coding validation, preferred

+ EHR experience

+ 3M-360 Computer Assisted Coding

Dept./Unit-Specific Skills:

+ IP Validator 3 level ICD-10-CM, ICD-10-PCS Inpatient code assignment skills based on BILH IP Coding Validator Exam

Key Business Relationships:

Coding Director: Day to day direction, scheduling and support

Medical Staff: Provide support, education and training

Coding colleagues: Process improvement, knowledge sharing, quality of work, productivity and training and education

External facilities: Work with hospitals, provider practices and vendors on requests related to Coding and Validation

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