DRG Coding Validator - Care New England

For the right candidate within the US Eastern/Central time, remote option may be available.*

This position requires Certification as a Certified Coding Specialist (CCS).

Job Summary

Under general supervision of the Clinical Documentation Improvement Manager, the Coding Validator 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 HCPCS assignments. The Coding Validator works closely with the CDI Manager, Coding Manager, Coding staff and collaborates with Clinical Documentation Improvement Specialists to assure coding uniformity, consistency and accuracy with ICD-10-CM, ICD-10-PCS, HCPCS coding guidelines, Official Coding Guidelines, Federal and State regulations, Coding Guidelines and relevant Coding Clinics. The Coding Validator is also responsible for exceeding quality and quantity expectations while performing coding functions to support timely coding and billing. This position includes Kent Hospital and Women and Infants Hospital.

Duties and Responsibilities

Demonstrates a comprehensive, expert-level of knowledge of all procedures concerning the sequencing of diagnoses, procedures including, but not limited to, those outlined in ICD-10-CM/PCS Uniform Hospital Discharge Data Set, Medicare guidelines and other appropriate classification systems.

Ensures correct use by the coding staff.

Ensures the accuracy and completeness of clinical information used for measuring and reporting.

Works closely with Coding and/or Clinical Documentation Improvement Specialist (CDIS) to evaluate inpatient coding.

Provides appropriate educational feedback with clinical support to Coding and/or CDI team related to coding and reimbursement recommendations.

Serves as a central resource for inpatient coding questions.

Educates all members of the patient care team regarding clinical documentation needs, changes to guidelines, coding and reimbursement issues.

Conducts validation of the DRG, secondary diagnoses, and procedure codes.

Recommends improvements in coding, and/or identifies query opportunities.

Uses assertive interpersonal skills to discuss clinical documentation issues and work effectively with Coding and/or CDI team.

May participate in external reviews such as, Recovery Auditors, and develops written appeals as needed.

Performs other related duties as assigned.

Requirements

High School Diploma or GED required.

Minimum of 5-7 years coding experience in inpatient setting, or 3-5 years related work experience.

Certification as a Certified Coding Specialist (CCS) required.

Certified Documentation Integrity provider (CDIP) or Certified Clinical documentation specialist (CCDS) preferred.

Knowledge of ICD-10-CM, ICD-10-CM/PCS.

Knowledge of Medicare, Medicaid and third-party coding requirements, including MS-DRGs, APR-DRGs and AP-DRGs.

Care New England Health System (CNE) and its member institutions—Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, and our Wellness Center—are trusted organizations fueling the latest advances in medical research, attracting the nation’s top specialty-trained doctors, and honing renowned services and innovative programs to engage in the important discussions people need to have about their health.

Americans with Disability Act Statement: External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case-by-case basis.

EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status

Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.