Validation engineer • providence ri
Reports to PFS Manager of Audit and Education.Supervises the staff who validates hierarchical condition category coding opportunities (HCCs) accurate coding and thorough documentation in order to a...[internal_linking.show_more]
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Summary:
Reports to PFS Manager of Audit and Education. Supervises the staff who validates hierarchical condition category coding opportunities (HCCs) accurate coding and thorough documentation in order to assure adherence to compliance guidelines as well as identify legitimate revenue opportunities. Assists Manager in providing feedback and education to coders and providers.Assists Manager with coordinating external audits and internal Compliance audits.
Responsibilities:
Performs audits of the validating team to assure all validation is consistent with coding guidelines and Lifespans billing coding and compliance policies.
Works with Manager to create annual validation schedule and validator goals. Ensures validators are performing timely and accurate audits and are meeting all goals of the department. Provide regular feedback to staff including praising them for their successes and mentoring/retraining as needed.
Oversees the staff that reviews medical records for risk adjustment opportunities and alerts providers of these in advance of patientsvisits. Works with Manager to monitor risk adjustment factor scores (RAFs).
Identifies coding trends and reports these trends to the Manager.
Maintains updated knowledge of all billing coding and compliance guidelines including but not limited to HiPAA CPT ICD-10 HCHPCS quality measures medical terminology etc. Applies this knowledge daily and educates staff.
Serves as the principal trainer to new staff and a resource to the team answers questions and provides guidance. Oversees the development and growth of the individual validators.
Acts as a resource for healthcare professionals in need of coding/documentation assistance.
Assists Manager with human resource issues including hiring evaluating implementing improvement/corrective action plans and terminations as needed.
Prepares payroll as requested.
Performs other duties as necessary.
Other information:
BASIC KNOWLEDGE:
Associate Degree or 3 years of experience in a medical coding/validating role.
Certification required:CCS CPC.RHIA or RHIT considered.
EXPERIENCE:
Three to five years progressively responsible experience performing outpatient coding.Experience in a large multispecialty physician group and/or complex academic medical center preferred.
One to two years supervisory experience strongly preferred.
Experience should demonstrate a high level of knowledge in ICD-10-CM and CPT-4 coding methodologies.
Effective written and oral communication skills and effective leadership/management skills required.
Experience with Epic preferred.
WORKING CONDITION AND PHYSICAL REQUIREMENTS:
INDEPENDENT ACTION:
Supervisory responsibility for up to 20 FTEs.
