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Outpatient Coding Validator

Cape Cod Healthcare

Hyannis, MA
Job Code:
  • Healthcare
  • Financial Services
  • Administrative / Clerical
Cape Cod Healthcare
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Job Details

Outpatient Coding Validator-180206-50007151
The Outpatient Coding Validator assists the Outpatient Coding Manager with oversight and evaluation of coding functions including accuracy efficiency continuing education needs and overall coding quality.
  • Audits and evaluates records to determine documentation consistency and adequacy to support coding levels and procedures assigned by providers and or coders Ensures that the final diagnosis is consistent with documentation and reflects the care and treatment rendered Reviews selected records for compliance with established regulatory and third party documentation requirements
  • Provides findings surrounding audit review activities to management
  • Conduct regular educational sessions with Coders (and other hospital staff as needed) on newly published coding guidelines or billing regulations to assure coding staff possess accurate information and follow new requirements
  • Assists management with the administration of education and training necessary evaluating the effectiveness of the education plan or performance improvement plans providing feedback to Coding Manager
  • Investigates and identifies resolution of coding edits in accordance to Medicare and Commercial insurance OCE editor and coverage policies provides education to staff
  • Assists management in the development and implementation in efficient and effective operational policies processes within the functions of coding which includes coding related edits
  • Serves as the resource person for the coding staff to answer questions and concerns as related to outpatient guidelines and procedures Refers questions as appropriate to the attention of the Coding Management
  • Assist management in the performance of the daily operations of the Coding Department
  • Provides input to Coding Management for employee evaluations
  • Demonstrates respect and regard for fellow employees to ensure a professional responsible and courteous environment Make sound judgments strong organizational independent problem solving and analytical skills
  • Maintain up to date working knowledge of all coding and reimbursement rules and regulations
  • Must stay current in all areas of coding and maintain continuing education units to remain credentialed
  • Prioritizes and manages multiple tasks simultaneously to effectively anticipate and respond to issues as needed in a dynamic work environment
  • Performs other job work related duties and assignments as requested

  • High School Diploma or GED Bachelors in Science preferred
  • A minimum of at least one of the following CCS (certified Coding Specialist) CCS P (Certified Coding Specialist Professional) CPC (certified Professional Coder) CPC H (Certified Professional Coder Hospital Outpatient RHIT RHIA
  • Knowledge and expertise in the following areas outpatient coding of ICD 9 10 CPT HCPCS and E M leveling required hospital reimbursement methodologies preferred
  • Minimum three (3) to five (5) years of coding experience in outpatient coding
  • Coding experience in an acute hospital setting preferred
  • Experience as a coding auditor preferred
  • Ability to read write and communicate in English
  • Excellent written verbal communication and interpersonal skills
  • Basic mathematics skills as demonstrated by successful passage of a basic mathematics test
  • Demonstrated ability to work effectively independently with department heads and supervisory staff
  • Maintains professional accreditations
  • Maintains up to date expertise and knowledge of healthcare coding regulations guidelines with a thorough understanding of federal state and Medicare OCE NCCI regulations and coverage policies
  • Experience with claim editing systems SSI preferred
  • Ability to use PC based office productivity tools (e g Microsoft Office) as necessary
  • Ability to work independently as well as in a team environment

Schedule Details: 40 hours per week, 8a-5p Monday-Friday
Organization: Cape Cod Hospital
Primary Location: Hyannis
Department: CCH-Medical Records
Employee Classification: Regular-Regular
Shift: Day
Weekend Shifts: None
Holiday Shifts: None
Posting Start Date: Feb 8, 2018
Posting End Date: Ongoing
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