Professional Coding Validator

Cape Cod Healthcare

Job Description

Responsible for performing quality reviews of professional medical records to validate the integrity of the Evaluation and Management, CPT procedural coding and ICD-10 diagnoses. Also act as an Educator for the Professional Coding staff.


Audits and evaluates records to determine documentation consistency and adequacy to support coding levels assigned by providers. 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.
Abide by AAPC and established regulatory standards of Ethical Coding when performing validation reviews and provide feedback to Professional Coding Manager of any potential compliance issues related to coding and physician documentation.
Analyzes provider documentation to assure the appropriate Evaluation & Management (E&M) coding levels are assigned using the correct and appropriate CPT code.
Provide guidance and education to Coders on validation findings to support compliant coding and increase knowledge and skills.
Conduct regular educational sessions with Coders on newly published coding guidelines or billing regulations to assure coding staff possess accurate information and follow new requirements.
Meet with providers to provide feedback and training to strengths/weaknesses identified in audit/review activities. Continue to monitor provider performance and perform additional reviews, instruction and guidance as needed to meet minimum coding accuracy standards.
Serve as an educational resource to hospital based physicians and staff for ongoing educational needs related to coding.
Develop curriculum and training materials for coding staff.
Revise and provide recommendations of best practice standards for coding policies and procedures.
Assist in review and assessment of audit findings from third parties that provide coding validation audits. Formulate and write appeals when appropriate and/or educate Coder(s) when required.
Provide coding support and answer coding questions for Patient Financial Services and other departments.
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.

Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers in a manner that reflects Cape Cod Healthcares commitment to CARES: compassion, accountability, respect, excellence and service.


High School graduate; 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)
Minimum of three to five years experience in Physician Coding, including experience in Evaluation and Management.
Specialty in E&M (CEMC), Certified Evaluation and Management Coder through the AAPC, or CPMA, Certified Professional Medical Auditor through the AAPC preferred.
Previous validation/auditing experience preferred.
Experience working with and educating providers preferred.
Must possess excellent communication skills.
Demonstrated ability to create strong working relations with physicians.
Excellent PC skills; proficient use of Microsoft Excel, PowerPoint and Word desired.
Capable of working independently as well as in a team environment.

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