SUMMARY: Ensures accurate coding and data quality, creating consistency and efficiency in inpatient and/or outpatient services through ongoing performance of ICD-10-CM and/or CPT coding validation 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 Differences Patient and Community Focus and Collaborate RESPONSIBILITIES: Performs coding quality reviews on inpatient records to validate the ICD-10-CM codes, DRG group appropriateness, missed secondary diagnoses and procedures, and ensures compliance with all DRG mandates and reporting requirements. Ensures validity of data prior submission of bill. Performs retrospective coding audits as required. Performs data quality reviews on outpatient encounters to validate the ICD-10-CM, CPT and HPCS Level II codes, modifier assignments, APC group appropriateness, missed secondary diagnosis and procedures and ensure compliance with all outpatient coding mandates. Ensures medical necessity criteria is met and local medical review polices are followed. Continuously evaluates the quality of the clinical documentation to spot incomplete or inconsistent documentation for inpatient encounters that impact code selection and resulting DRG groups and payments. Brings identified concerns to department manager for resolution. Provides training for coding staff and educates facility healthcare professionals in the use of coding guidelines and practices, proper documentation techniques, medical terminology and disease processes as it relates to the MS DRG, APR DRG and/or outpatient APC and other clinical data quality management. Maintains knowledge of current professional coding certification requirements. Reviews LifeChart coding validator, coding error and CED work queues. Identifies any coding or coding related charge issues to leadership. Performs routine coding validation audits. Prepares reports for director on coder accuracy results. Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and monitors coding staff for violations and reports to Coding Manager when areas of concern are identified. 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 certification program. Understanding of the content of the medical record. Trained in medical terminology, medical science, disease processes anatomy and physiology. Ability to recognize and understand clinical documentation pertinent for coding. Good writing skills to prepare compliant physician queries. Computer literate; capable of researching websites to access regulatory requirements. Ability to navigate the patient electronic medical record. Coding specialist certification required. EXPERIENCE: Five years coding optimization experience in an acute care facility. Past auditing experience or strong training background in coding preferred. WORKING CONDITIONS AND PHYSICAL REQUIREMENTS: After orientation at the hospital’s facilities, work is performed at the employee’s residence in accordance with provisions of a telecommuting work agreement, to which the employee has agreed as a condition of working in an off-campus location. The hospital’s normal office and central work location environment applies for assignments, meetings, and other requirements as determined by department management. INDEPENDENT ACTION: Performs independently within the department’s policies and procedures. Refers specific complex problems to the supervisor when clarification of the departmental policies and procedures 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