Validator

Requisition #: 230781

Title: Validator

Status: Exempt

Shift: Days

Union:  non union

Hours: 40

Shift Length: 8

Location: UMass Memorial Medical Center

Position Summary:

Performs focused account and quality reviews of coded records to support the ongoing performance management process. Validates the Diagnosis Related Group (DRG) and current editions of ICD-CM, ICD-PCS, and CPT code assignment to ensure consistency and efficiency in the processing, data collection, and quality reporting associated with inpatient and outpatient claims.

Major Responsibilities:

• Performs focused account and Coder quality reviews on inpatient and outpatient records to validate the DRG and current editions of ICD-CM, ICD-PCS, and CPT code assignment as well as missed secondary diagnoses or procedures which may impact the Severity of Illness (SOI) and Risk of Mortality (ROM).
• Ensures compliance with all DRG, outpatient coding, and charging mandates as well as reporting requirements.
• Validates the DRG and current editions of ICD-CM, ICD-PCS, and CPT code assignment to ensure consistency and efficiency in the processing, data collection, and quality reporting associated with inpatient and outpatient claims.
• Demonstrates competency in the use of computer applications, DRG grouper software, as well as all coding and abstracting software currently used in HIM.
• Runs daily reports to ensure all focused account reviews are worked to prevent the unnecessary holding of accounts prior to billing. Informs the Manager of Coding-HIM when backlog situations arise and necessary documents are either incorrect or not received in a timely manner.

Position Qualifications:

License/Certification/Education:

Required:

• Bachelor’s degree in Business or Health Care Administration.
• Certification as a Certified Coding Specialist (CCS).

Preferred:

• Certification as a Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT).

Experience/Skills:

Required:

• 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.
• Excellent customer service skills with the ability to communicate efficiently.
• Exceptional organizational skills with attention to detail.
• Ability to lead, organize, and support the work of less senior Coders is a primary function of this position.
• Ability to work independently within established guidelines.
• Excellent oral and written communication skills required.
• Ability to motivate, train and teach individuals; demonstrating skills in interpersonal relationships and in oral and written communication.
• Ability to organize and coordinate multiple functions and tasks.
• Ability to problem solve, organize, and prioritize workload to meet productivity benchmarks.
• Ability to withstand significant level of on-going pressure, and ability to deal with individuals with tact, discretion and diplomacy.

Preferred:

• 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.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.