Inpatient Coding Validator III

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

An Inpatient 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 imbursement impacting elements.

**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:​

• 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 Indicator and Hospital Acquired Condition reviews.

• Performs monthly post-bill coding audits

• Performs focused DRG audits

• Performs data and analysis of coding quality data to identified coding error trends.

• Reviews findings of third-party coding audits.

• Prepares appeal letters to third part 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 Epic.

• 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.

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:

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

Experience:

• Computer skills

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

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

• Microsoft Office applications

Required Qualifications:

•  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 EMR 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
   

Preferred Qualifications & Skills:

• Epic experience

• 3M-360 Computer Assisted Coding

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

As a health care organization, we have a responsibility to do everything