Job Details

SUMMARY:Ensures accurate coding anddata quality, creating consistency and efficiency in inpatient and/oroutpatient services through ongoing performance of ICD-10-CM and/or CPT codingvalidation and accurate MS DRG, APR DRG and/or outpatient APC.Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include:Instill Trust and Value DifferencesPatient and Community Focus and CollaborateRESPONSIBILITIES:Performs coding quality reviews on inpatient records tovalidate the ICD-10-CM codes, DRG group appropriateness, missed secondarydiagnoses and procedures, and ensures compliance with all DRG mandates andreporting requirements. Ensuresvalidity of data prior submission of bill. Performs retrospective coding auditsas required.Performs data quality reviews on outpatient encounters tovalidate the ICD-10-CM, CPT and HPCS Level II codes, modifier assignments, APCgroup appropriateness, missed secondary diagnosis and procedures and ensurecompliance with all outpatient coding mandates.Ensures medical necessity criteria is met and local medical reviewpolices are followed.Continuously evaluates the quality of the clinicaldocumentation to spot incomplete or inconsistent documentation for inpatientencounters that impact code selection and resulting DRG groups andpayments. Brings identified concerns todepartment manager for resolution.Provides training for coding staff and educates facilityhealthcare professionals in the use of coding guidelines and practices, properdocumentation techniques, medical terminology and disease processes as itrelates to the MS DRG, APR DRG and/or outpatient APC and other clinical dataquality management. Maintains knowledge of current professional codingcertification requirements.Reviews LifeChart coding validator, coding error and CEDwork queues. Identifies any coding or coding related charge issues toleadership. Performs routine coding validation audits. Prepares reports for director on coderaccuracy results.Abides by the Standards of Ethical Coding as set forth bythe American Health Information Management Association and monitors codingstaff for violations and reports to Coding Manager when areas of concern areidentified.Provides direction to coding staff in absence of management.MINIMUM QUALIFICATIONS:BASIC KNOWLEDGE:Associate degree in health information technology(preferably with RHIT) and/or successful completion of coding certificationprogram. Understanding of the content ofthe medical record. Trained in medicalterminology, medical science, disease processes anatomy and physiology. Abilityto recognize and understand clinical documentation pertinent for coding. Good writing skills to prepare compliant physicianqueries. Computer literate; capable ofresearching websites to access regulatory requirements. Ability to navigate the patient electronicmedical record. Coding specialistcertification required.EXPERIENCE:Five years coding optimization experience in an acute carefacility. Past auditing experience orstrong training background in coding preferred.WORKING CONDITIONS AND PHYSICAL REQUIREMENTS:After orientation at the hospital's facilities, work isperformed at the employee's residence in accordance with provisions of atelecommuting work agreement, to which the employee has agreed as a conditionof working in an off-campus location.The hospital's normal office and central work location environmentapplies for assignments, meetings, and other requirements as determined bydepartment management.INDEPENDENT ACTION:Performs independently within the department's policies andprocedures. Refers specific complexproblems to the supervisor when clarification of the departmental policies andprocedures are required.SUPERVISORY RESPONSIBILITY:None.

Pay Range:

$30.39-$50.16

EEO Statement:

Brown University Health is an Equal Opportunity 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:

Corporate Headquarters - 167 Point Street Providence, Rhode Island 02903

Work Type:

Mon-Fri with weekends possible-Flex

Work Shift:

Variable

Daily Hours:

8 hours

Driving Required:

No