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Summary: Ensures accurate coding and
data quality creating consistency and efficiency in inpatient and/or
outpatient services through ongoing performance of ICD-10-CM and/or CPT coding
validation and accurate MS DRG APR DRG and/or outpatient APC. Responsibilities: Performs coding quality reviews on inpatient records to
validate the ICD-10-CM codes DRG group appropriateness missed secondary
diagnoses and procedures and ensures compliance with all DRG mandates and
reporting requirements. Ensures
validity of data prior submission of bill. Performs retrospective coding audits
as required. Performs data quality reviews on outpatient encounters to
validate the ICD-10-CM CPT and HPCS Level II codes modifier assignments APC
group appropriateness missed secondary diagnosis and procedures and ensure
compliance with all outpatient coding mandates.
Ensures medical necessity criteria is met and local medical review
polices are followed. Continuously evaluates the quality of the clinical
documentation to spot incomplete or inconsistent documentation for inpatient
encounters that impact code selection and resulting DRG groups and
payments. Brings identified concerns to
department manager for resolution. Provides training for coding staff and educates facility
healthcare professionals in the use of coding guidelines and practices proper
documentation techniques medical terminology and disease processes as it
relates to the MS DRG APR DRG and/or outpatient APC and other clinical data
quality management. Maintains knowledge of current professional coding
certification requirements. Reviews LifeChart coding validator coding error and CED
work queues. Identifies any coding or coding related charge issues to
leadership. Performs routine coding validation audits. Prepares reports for director on coder
accuracy results. Abides by the Standards of Ethical Coding as set forth by
the American Health Information Management Association and monitors coding
staff for violations and reports to Coding Manager when areas of concern are
identified. Provides direction to coding staff in absence of management. Other information: BASIC KNOWLEDGE: Associate degree in health information technology
(preferably with RHIT) and/or successful completion of coding certification
program. Understanding of the content of
the medical record. Trained in medical
terminology medical science disease processes anatomy and physiology. Ability
to recognize and understand clinical documentation pertinent for coding. Good writing skills to prepare compliant physician
queries. Computer literate; capable of
researching websites to access regulatory requirements. Ability to navigate the patient electronic
medical record. Coding specialist
certification required. EXPERIENCE: Five years coding optimization experience in an acute care
facility. Past auditing experience or
strong training background in coding preferred. WORKING CONDITIONS AND PHYSICAL REQUIREMENTS: After orientation at the hospital*s facilities work is
performed at the employee*s residence in accordance with provisions of a
telecommuting work agreement to which the employee has agreed as a condition
of working in an off-campus location.
The hospital*s normal office and central work location environment
applies for assignments meetings and other requirements as determined by
department management. INDEPENDENT ACTION: Performs independently within the department*s policies and
procedures. Refers specific complex
problems to the supervisor when clarification of the departmental policies and
procedures are required. SUPERVISORY RESPONSIBILITY: None. Brown University Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status. Brown University Health is a VEVRAA Federal Contractor. Location: Brown University Health Corporate Services USA:RI:Providence Work Type: Full Time Shift: Shift 4 Union: Non-Union
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Lifespan
Mar 08, 2025