Coding Validator

This is a fully remote position, open to applicants in Rhode Island.

📋 Description

• Reports to the PFS Manager who oversees audit and educational initiatives.

• Conducts audits of coders and providers for ICD-10, CPT, and HCPCS codes.

• Develops training materials and delivers educational support as necessary.

• Keeps updated on industry and payer modifications related to coding and documentation standards.

• Audits professional ambulatory medical records for a multispecialty provider organization to ensure that billed codes are properly substantiated by documentation.

• Possesses knowledge of teaching physician regulations, including incident-to services, split/shared visits, and attestation requirements.

• Reviews diagnoses, procedures, and modifiers assigned by coders and documents outcomes.

• Shares completed audit findings with the Validation Team Leadership, who will communicate results to the Coding Manager and/or Director.

• Remains informed about coding and documentation standards, compliance policies, annual coding updates, payer guidelines, and industry developments.

• Identifies coding/documentation trends that may present a risk to Brown University Health or its revenue and reports these trends to the management team.

• Suggests enhancements to documentation templates in Epic to reduce compliance risks and enhance accurate documentation for providers.

• Ensures that documentation can withstand scrutiny during external audits.

• Collaborates with Practices/Clinics, Providers, Coding Team, Corporate Compliance, Risk Management, Contracting, and Payers to ensure all departments are aligned and can provide accurate feedback to coders and providers.

• Adheres to the Standards of Ethical Coding established by the American Academy of Professional Coders and the American Health Information Management Association.

• Performs additional duties as assigned.

⛳️ Requirements

• Successful completion of a coding certification program (CPC).

• Comprehension of the medical record content.

• Trained in medical terminology, medical science, anatomy, and physiology.

• Ability to recognize and interpret clinical documentation relevant to coding.

• Strong writing skills to clearly communicate coding/documentation issues.

• Proficient in computer use; capable of researching websites for regulatory requirements.

• Ability to navigate the patient electronic medical record.

• Excellent verbal and written communication skills.

• Proficient in Microsoft Word, Excel, and other computer applications.

• A minimum of five years of coding experience, ideally in a large, academic multispecialty organization.

• Previous auditing experience or a robust background in coding is preferred.

🏝️ Benefits

• Comprehensive health and wellness programs.

• Opportunities for professional development and continuing education.

• Supportive and collaborative work environment.