ED Coding Validator - REMOTE

Are you an internal caregiver, student, or contingent worker/agency worker at UMass Memorial Health?  to apply through your Workday account.

Exemption Status:

Exempt

Hiring Range:

$68,369.60 - $

Please note that the final offer may vary within this range based on a candidate's experience, skills, qualifications, and internal equity considerations.

Schedule Details:

Scheduled

Hours:

Shift:

1 - Day Shift, 8 Hours (United States of America)

Hours:

40

Cost Center:

99940 - 5458 Coding Services

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other.

And everyone, in their own unique way, plays an important part, every day.

Performs focused account and quality reviews of coded records to support the ongoing performance management process. Validates current editions of ICD-CM and CPT code assignment to ensure consistency and efficiency in the processing, data collection, and quality reporting associated with outpatient emergency department claims.

Major Responsibilities:

1. Performs focused account and Coder quality reviews outpatient records to validate current editions of ICD-CM and CPT code assignment as well as missed secondary diagnoses or procedures which may impact reimbursement.

2. Ensures compliance with all outpatient coding and charging mandates as well as reporting requirements.

3. Validates professional and facility Evaluation and Management CPT code assignment to ensure consistency and efficiency in the processing, data collection, and quality reporting associated with outpatient claims.

4. Demonstrates competency in the use of computer applications, code finder software, as well as all coding and abstracting software currently used in HIM.

5. Runs daily reports to ensure all focused account reviews are worked to prevent the unnecessary holding of accounts prior to billing. Informs the Manager of Coding Education and Quality when backlog situations arise, and necessary documents are either incorrect or not received in a timely manner.

6. Provides feedback on Coder quality reviews to the Director of Coding Services-HIM, Manager of Coding Education and Quality, Manager of ED Coding-HIM, Supervisor of ED Coding based on the Coding Audit and Performance Management policy and procedure.

7. Creates and monitors outpatient reports and accuracy of diagnoses to identify patterns, trends, and variations in the organization's frequently assigned diagnoses, evaluation and management codes, modifiers, and CPT procedure changes.

8. Evaluates the root cause of any identified trends or possible problem areas. Reports variances to the Manager of Coding Education and Quality-HIM, Manager of ED Coding, and Supervisor of ED Coding.

9. Acts as a point person for Coding staff on questions or concerns related to ICD-CM (current edition), Evaluation and Management (E/M) code assignment as well as procedural coding and the retrospective query process.

10. Maintains direct and ongoing communications with Coding personnel to maximize overall effectiveness and efficiency of coding operations.

11. Informs Manager(s) of any coding irregularities or trends contrary to policies / procedures and communicates with appropriate staff if necessary.

12. Assists the Manager of Coding Education and Quality-HIM, Manager of ED Coding in performance improvement initiatives and demonstrates the use of quality improvement in daily operations.

13. Assists the Manager of Coding Education and Quality-HIM in meeting department / unit goals and ensuring compliance with regulatory agencies such as Joint Commission, DPH, etc.

14. Monitors retrospective queries for appropriateness and may provide Coder feedback. Informs the Manager of Coding Education and Quality-HIM of any identified concerns.

15. Provides ongoing education to the Coding staff, Providers, and other clinicians to ensure appropriate assignment of current edition of ICD-CM, E/M codes as well as modifiers and CPT procedure changes.

16. Collaborates with the Manager of Coding Education and Quality to incorporate improvement efforts into coding in-services throughout the year.

17. Assists the Manager of Coding Education and Quality-HIM in preparing productivity reports and participates in the department's total quality management studies.

18. Maintains accuracy rate of not less than 95% for optimal reimbursement as well as department productivity standards as outlined in department policies.

19. Attends required training classes and coding in-services each year to stay…