Charge Capture Coding Specialist

Exemption Status: Non-Exempt

Hiring Range: $22.29 - $32.04. Please note that the final offer may vary within this range based on a candidate’s experience, skills, qualifications, and internal equity considerations.

Schedule

• Monday through Friday
• Scheduled Hours: 7:00 AM – 3:30 PM
• Shift: Day Shift, 8 Hours
• Hours: 40 per week

This position may have a signing bonus available; a member of the Recruitment Team will confirm eligibility during the interview process.

About the Role

At UMass Memorial Health, everyone is a caregiver—regardless of their title or responsibilities. Exceptional patient care, academic excellence, and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where you can build the career you deserve. We are more than 20,000 employees working together as one health system in a relentless pursuit of healing for our patients, community, and each other.

Responsibilities

• Interprets clinical and diagnostic documentation to process or pro-fee charges for episodes of outpatient/inpatient care.
• Assigns appropriate ICD-CM (current edition) and/or CPT codes as well as modifiers, adhering to official coding guidelines.
• Performs analysis on documentation, including review of tests/reports to determine the appropriate ICD-CM and/or CPT codes and modifiers as defined by official coding guidelines and other recognized reference materials (e.g., Optum Encoder, CCI edits, leveling).
• Verifies documentation is present to substantiate codes assigned.
• Assists in resolving incomplete and/or missing chart documentation to expedite coding and billing.
• Participates in the continuous coding audit and performance management program.
• Maintains coding accuracy rate of not less than 95% for optimal reimbursement and meets department productivity standards as outlined in department policies.
• Attends required training classes and coding in-services each year to stay abreast of new regulations and coding guidelines.
• Participates in improvement efforts and documentation training for medical and clinical staff as it relates to coding practices and guidelines.
• Communicates to Manager when backlog situations arise or necessary documents are either incorrect or not received in a timely manner.
• Refers all unusual or questionable situations to the direct Supervisor/Manager.
• Alerts management to any coding irregularities or trends contrary to policies/procedures so corrective measures may be taken.
• Adheres to coding and billing regulations established by the American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS).
• Maintains direct and ongoing communications with other coding personnel to maximize overall effectiveness and efficiency of the operation.
• Keeps current with all coding updates and information related to correct coding.

Requirements

• High School diploma or equivalent.
• Successful completion of a Medical Billing and Coding Program.
• Coding Certification in Professional Coding or must be obtained within 6 months of acceptance as a condition of employment.
• Knowledge of medical terminology.
• Knowledge of ICD-CM (current edition) and CPT coding systems as well as CCI edits.
• Knowledge of third-party payer requirements as well as federal and state guidelines and regulations pertaining to coding and billing practices.
• Good interpersonal and communication skills; demonstrates professionalism.
• Good customer service skills with the ability to communicate efficiently.
• Good organizational skills with attention to detail.
• Ability to work independently within established guidelines.
• Ability to problem solve, organize, and prioritize workload to meet productivity benchmarks.

Preferred Qualifications

• One (1) year of medical abstraction and outpatient coding experience or related work experience.

Unless certification, licensure, or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed may be substituted for the above requirements.