Coding Specialist - Inpatient Coding (Remote)
Mass General Brigham(PHS)

Job Info

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As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women's Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.

We're focused on a people-first culture for our system's patients and our professional family. That's why we provide our employees with more ways to achieve their potential. Mass General Brigham is committed to aligning our employees' personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development-and we recognize success at every step.

Our employees use the Mass General Brigham values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.

General Summary/ Overview:
Reporting to the Corporate Coding Operations Manager, and/or under the direction of a designee, the Coding Specialist - Inpatient Coding is responsible for accurate coding and/or charging of inpatient and/or outpatient (may include same day surgery, observation, hospital clinic and/or emergency service diagnoses and conditions) accounts based on medical record documentation. Other responsibilities may include resolving account and claim edits by reviewing appropriate medical record documentation. The coder will utilize coding classification systems including ICD-10-CM, ICD-10-PCS and/or CPT-4/HCPCS as well as other specialty systems as required by diagnostic category. They will assure appropriate assignment of DRG, APC and APG's as applicable to their role. All work is carried out in accordance with the department's approved polices and procedures. Where appropriate interacts with CDI Nurses, Physicians, and other Clinicians to gain clarity of medical documentation inconsistencies or request additional documentation so that all relevant diagnoses and procedures can be collected for payment and quality reporting.

Principal Duties and Responsibilities:

• Analyzes medical information documented in medical record and codes all ICD-10-CM diagnoses and/or ICD-10-PCS and CPT-4/HCPCS procedures according to the appropriate classification system for the category of patient encounter and based on relevant medical record documentation.
• Applies and follows Official Coding Guidelines, AHIMA Standards of Ethical Coding and facility-specific coding guidance when assigning diagnoses and procedures; grouping for the DRG; establishing E/M levels; and/or resolving coding claim edits.
• Completes coding, charging, and coding related claim edit resolution with an error rate of no less than 5% and maintains an average productivity level at or above the established coding role benchmark.
• Uses available coding related resources and references to research and support coding decisions and seeks input from department subject matter experts as needed.
• Follows code sequencing instructions, POA criteria, and use of modifiers as applicable.
• Demonstrates understanding of the Prospective Payment Systems methodologies, i.e. DRG, APG/APC.
• Demonstrates initiative and follows specified procedures to resolve issues with accounts that cannot be coded.
• If necessary, and depending on coding role, requests clarification for incomplete, illegible, contradicting, or unclear documentation either directly or through the Data Quality Specialist for Clinical Documentation Specialist.
• Participates in ongoing quality control programs that includes the following: reviews with Data Quality Specialist, Technical Advisors and/or 3rd party vendors. Update accounts as needed and adheres to any remediation programs established for areas of deficiency.
• Understands the coder role and how it relates to patient care, quality reporting, casemix index, and reimbursement methodologies.
• Proactively practices departmental and hospital confidentiality policies and procedures.
• Attends department staff meetings, and MGB and Revenue Cycle Operations meetings as advised.
• Participates and completes department-sponsored workshops and continuing education programs relevant to clinical processes and coding.
• May be asked to assist with training and workflow reviews for new staff.
• Performs coding, charging and/or claim edit resolution responsibilities for any entity covered by RCO Coding as needed.
• Responsible to perform other assigned duties as assigned.

Qualifications
Qualifications:

• Associate's or Bachelor's degree in Health Information Technology/Administration required
• CCS with previous coding experience required in lieu of Associate's or Bachelor's degree
• College level courses in medical terminology, biology, anatomy and physiology, basic pathology, ICD-10-CM/PCS and CPT coding are required
• Academic Medical Center Coding: 1-3 years broad ranged coding experience including extensive ICD-9, ICD-10-CM/PCS and CPT-4, inpatient and outpatient coding guidelines, and payor policies is required. Strong inpatient and/or outpatient coding experience is required.
• Community Hospital Coding: 1 year of coding experience in using ICD-10-CM, ICD-10/PCS, and/or CPT-4 in the Inpatient, Ambulatory or ED coding environment is required.
• RHIA, RHIT or CCS by AHIMA or appropriate AAPC coding credentials required. Coding credential eligible may be considered with significant coding experience but coding credentials would be required within 1 year of hire.
• Must maintain AHIMA and/or AAPC credentialing by meeting or exceeding Continuing Education Requirements and passing annual coding test as required for credentialing maintenance.
• A combination of education and experience may be substituted for requirements.

Skills/Abilities/Competencies:

• Up-to-date and in-depth knowledge of anatomy, physiology, medical science, medical terminology, normal and abnormal laboratory values, and generic and brand name drugs for a detailed review of paper and/or computerized medical records for abstracting,coding accuracy, and completion.
• Expert knowledge of ICD-10-CM/ICD-10-PCS and/or CPT/HCPCS coding systems (relevant to coding role) to assign the most precise code possible and to abstract specific clinical data to support hospital-wide case mix activities.
• Exercises judgment to review the medical record for ambiguities and/or contradictory material; able to discern when another coder and/or physician opinion is needed.
• Ability to process accurate work, within presented time frames.
• Strong analytical skills and ability to pay close attention to detail.
• Ability to work as a teammate.
• Demonstrates the ability to assume responsibility for professional development and ongoing education to maintain proficiency.
• Ability to accept constructive feedback based on analysis from inside/outside auditors and quality improvement initiatives.
• Maintain confidentiality with regard to Protected Health Information (PHI).
• Ability to withstand the pressure of continual deadlines and receipt of work with variable requirements.
• Ability to be courteous, thoughtful, and collaborative throughout the working day.
• Ability to communicate clearly and professionally, both written and verbal, with all levels of staff and personnel within the organization.
• Proficiency and understanding of how to use standard office equipment such as desktop computers, telephones, and computer applications that facilitate communication such as email, teleconference, web conference etc.

Supervisory Responsibilities:
No direct reports; may indirectly provide leadership and guidance to less seasoned and new staff.

Fiscal Responsibility:
Demonstrates fiscal responsibility by effectively using MGB resources.

Working Conditions:
100% Remote position; requires all work done on computer and is 100% sedentary. RCO Coding provides equipment for remote coders; employee responsible for wifi and telephone connections.

#LI-Remote

EEO Statement
Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.

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