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Coding Quality Validator

Location New Jersey, United States
Posted 06-September-2018
Description
Responsibilities: 1. Reviews DRG assignment for selected Medicare/Medicaid inpatients, HAC, PSI and Healthgrade target diagnoses for the purpose of reimbursement, research and statistics in compliance with federal regulations according to ICD-9, ICD-10 and CPT-4 coding classification systems. 2. Analyzes physician documentation in the medical record for clinical correlation for coding accuracy and queries physicians when code assignments are not straightforward or documentation in the medical record is inadequate, ambiguous, or unclear for coding purposes. 3. Provides guidance on any changes made during their review to the Inpatient Coders by furnishing input as necessary in addition to education regarding applicable coding clinics or coding guidelines. 4. Analyzes clinical data of CDMP Severity Complexity worksheets and applies tracking codes. 5. Provides guidance to the Clinical Documentation Specialists by furnishing input as necessary in addition to education regarding applicable coding clinics or coding guidelines. 6. Performs data analysis and statistical gathering on a monthly basis with regards to DRG, CPT, Public Reporting, HAC compliance which is then presented to the Chief Compliance Officer 7. Makes recommendations on documentation improvement needs within the facility to improve patient care. 8. Applies POA indicators on all inpatient charts. 9. Brings identified concerns to supervisor or department manager for resolution. 10. Enters data such as diagnosis and procedure codes and charts abstracted information for APC and DRG assignments into the 3M coding computer system. 11. Assists the Inpatient HIM Supervisor and Inpatient Coding Manager with education sessions for coding staff. 12. Assists in chart completion to ensure DNFB goals are met. 13. Assists in special projects when applicable such as in-house audits or audits pertaining to contract coders. 14. Creates spreadsheets and summary of findings. 15. Attends monthly coding in-services provided by the Inpatient Coding Educator. 16. Assists the coding staff when needed. 17. Keeps abreast of coding guidelines and reimbursement reporting requirements, new technology and procedures as well as CMS approved clinical trials. 18. Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines. 19. Adheres to standards identified in the Medical Center's Organizational Competencies.
Qualifications Education, Knowledge, Skills and Abilities Required: 1. Associate's degree or higher or equivalent years of experience. 2. Minimum of 5 years of inpatient coding experience in a complex healthcare environment. 3. Minimum 2 years of quality improvement audit. 4. Experience and thorough knowledge of ICD-9, ICD-10, CPT and DRG methodologies. 5. Knowledge of data reporting requirements and proficiency in computer skills. 6. Extensive knowledge in data collection and clinical reviews. 7. Excellent written, verbal, and interpersonal communication skills. Education, Knowledge, Skills and Abilities Preferred: Licenses and Certifications Required: Licenses and Certifications Preferred: 1. Registered Health Info Tech License or Registered Health Information Administrator Certification or Certified Coding Specialist or NJ State Professional Registered Nurse License.

 
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