Inpatient Coding Specialist
4 days ago
We are seeking a highly skilled Inpatient Coding Validator to join our team at UMass Memorial Health. As a key member of our Coding Services department, you will be responsible for ensuring the accuracy and consistency of medical records and coding data.
Key Responsibilities- Perform focused account and coder quality reviews on inpatient and outpatient records to validate DRG and current editions of ICD-CM, ICD-PCS, and CPT code assignment.
- Ensure compliance with all DRG, outpatient coding, and charging mandates as well as reporting requirements.
- Validate DRG and current editions of ICD-CM, ICD-PCS, and CPT code assignment to ensure consistency and efficiency in processing, data collection, and quality reporting.
- Demonstrate competency in the use of computer applications, DRG grouper software, and all coding and abstracting software currently used in HIM.
- Run daily reports to ensure all focused account reviews are worked to prevent unnecessary holding of accounts prior to billing.
- Provide feedback on coder quality reviews to the Manager of Coding-HIM, Supervisor of Inpatient Coding, Manager of Emergency Department Coding, and Manager of Radiology Coding based on the Coding Audit and Performance Management policy and procedure.
- Create and monitor Case Mix Index (CMI) reports and accuracy of the top 25 assigned DRGs to identify patterns, trends, and variations.
- Create and monitor outpatient reports and accuracy of top 25 assigned principle diagnoses to identify patterns, trends, and variations in the organization's frequently assigned principle diagnoses, evaluation and management codes, modifiers, and CPT procedure changes.
- Evaluate the root cause of any identified trends or possible problem areas and report variances to the Manager of Coding-HIM, Manager of ED Coding, and Manager of Radiology Coding.
- Monitor retrospective queries for appropriateness and may provide coder feedback, informing the Manager of Coding-HIM of any identified concerns.
- Bachelor's degree in Business or Health Care Administration.
- Certification as a Certified Coding Specialist (CCS).
- Minimum of five (5) years of experience coding in a large, teaching, acute tertiary care setting with demonstrated coding expertise.
- Extensive knowledge of current editions of DRGs, ICD-CM, ICD-PCS, and CPT coding systems.
- Through knowledge of third-party payer requirements as well as federal and state guidelines and regulations pertaining to coding and billing practices.
- General knowledge of hospital information systems as well as extensive knowledge of computer systems/applications used in HIM.
- General knowledge of the retrospective CDI query process as well as guidelines for achieving a compliant query and associated compliance concerns.
- Coding review experience in DRG assignment, and current editions of ICD-CM, ICD-PCS, and CPT coding with previous claims processing and data management responsibility.
UMass Memorial Health is an equal opportunity and affirmative action employer, recognizing the power of a diverse community and encouraging applications from individuals with varied experiences, perspectives, and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity, and expression, protected veteran status, or other status protected by law.
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