Review patient records to ensure documentation supports appropriate billing and coding; including diagnoses, services rendered, and medical necessity.
Identify documentation gaps that may impact reimbursement, compliance, or patient care. Work with providers to resolve them.
Assist providers in understanding documentation requirements related to coding Standards (e.g., CPT, ICD-10) and payer guidelines.
Conduct routine chart audits to validate accuracy and alignment between clinical documentation and billing data.
Collaborate with the billing department to ensure clean claims and reduce denials or rework.
Provide real-time or retrospective feedback to clinicians to improve documentation practices
Track trends in documentation errors, coding issues, and claim denials. Report findings on leadership.
Support compliance with HIPAA, state regulations, and payer-specific requirements.
Develop training materials and provide education to medical and clinical staff on best practices for documentation, billing, and coding
Assist in the management of organizational projects as needed.
Assists in evaluating and standardizing operations, policies, and procedures.
Assist with training and education of staff upon request

Associate or Bachelor's degree in health information management, Healthcare Administration, Nursing, or related field preferred
High School Diploma/GED Required
Certified Professional Coder Certification preferred
2+ years of experience in healthcare data validation, clinical documentation improvement (CDI), medical billing/coding, or chart auditing.
NextGen software experience preferred.
High attention to detail and strong organization skills are essential.
Experience using electronic health care records.
Excellent interpersonal skills, capable of confidently and effectively presenting and speaking.
Able to work independently, collaboratively, and proactively to accomplish work goals.
Excellent computer skills.
Proficient in basic data analysis, reporting to include spreadsheets, charts, and diagrams.
Proficient in Microsoft Office Suite and managing projects through a full cycle process.
Must have a Fingerprint clearance card or be eligible to obtain one.

Data Validation Administrator

Key skills