Coding Validation Spec 2
Job DescriptionAs a Coding Validation Specialist 2, you will perform daily validation of encounters performed in assigned locations to ensure that charges entered into the EPIC charging system are valid. To help achieve our mission, you will verify the accuracy, completeness and precision of ICD-10-CM, CPT-4 and HCPC coding including modifiers, units and other variables impacting workload accountability and billing. Your ability to independently re-code the encounter from source documentation, complete supporting worksheets documenting rationale for coding decisions, record discrepancies and record the rationale for changes in coding decisions is of vital importance. Maintaining knowledge of coding, regulatory and payer guidelines to ensure that all Inova Health System coding and documentation meets regulatory guidelines, audit standards and results in appropriate reimbursements is required.
- Codes and reviews assigned records within the defined quality standards of 95 percent for diagnosis, CPT, modifier and evaluation/management code assignments.
- Ensures that the coding and review of assigned records within the defined productivity standards, based on service-line production standards, equate to eight – 10 charts per hour.
- Actively participates in coding education sessions.
- Reviews and analyzes all pertinent documentation in the medical record to support identification and assignment of appropriate code selection for the level of service provided by the physician or mid-level provider.
- Reviews and revises, as necessary, required data elements initially identified by other staff (e.g. patient type, admit diagnosis, referring physician for consult codes or admit type with appropriate place of service).
- Ensures correct CPT code selection for the level of service billed (i.e. POS to IP code mismatch, or invalid code for POS; change consult code to E/M based on payer specific criteria).
- Communicates with responsible physician or mid-level provider accordingly to obtain additional supporting documentation, or clarification required for code assignments and processes, to include following an escalation or secondary review as necessary.
- Assigns and revises all codes, modifiers and edits using 3M coding software.
High School or GED
One of the following credentialing required: CPC-A, CPC, COC, CCS, CSS-P, CCA or RHIT
Effective verbal/written communication skills, as well as strong interpersonal skills are required. Computer literacy, proficient with Microsoft Office and ability to work independently in a production driven environment.