Inpatient Coding Quality & Education Specialist

About the role

The Inpatient Coding Quality & Education Specialist serves as a subject matter expert in ICD-10-CM/PCS coding, coding quality, clinical data integrity, and coding-related performance improvement initiatives. This role supports organizational goals related to coding accuracy, quality outcomes, reimbursement integrity, compliance, and operational efficiency through coder education, auditing, onboarding, data analysis, and collaboration with multidisciplinary stakeholders.

Responsibilities

• Coding Quality & Audit Activities:

  • Perform pre-bill and post-bill coding audits utilizing internal and third-party audit platforms and vendor software.
  • Review coded accounts for coding accuracy, reimbursement integrity, quality reporting implications, and compliance with coding guidelines.
  • Analyze audit findings to identify trends, educational opportunities, and systemic process improvement initiatives.
  • Collaborate with Coding Operations, Quality, CDI, Revenue Integrity, and Compliance teams to address identified findings and implement corrective actions.
  • Track, trend, and report audit outcomes to leadership and operational stakeholders.
  • Support external audit preparedness and validation activities, including payer, regulatory, and vendor reviews.

• Education & Training:

  • Lead onboarding and competency development for newly hired inpatient coders or Data Quality Specialists.
  • Develop and deliver coding education related to ICD-10-CM, ICD-10-PCS, Official Coding Guidelines, Coding Clinic advice, regulatory updates, and organizational policies.
  • Create educational materials, tip sheets, job aids, presentations, and learning resources.
  • Facilitate individual and group education sessions based on audit findings, quality trends, and operational needs.
  • Support ongoing professional development and coding competency initiatives.

• Quality & Clinical Data Integrity:

  • Collaborate with quality, CDI, and operational teams to evaluate coding impacts on quality reporting and benchmarking methodologies.
  • Analyze coding opportunities affecting Vizient, Elixhauser, mortality, severity of illness, risk of mortality, expected length of stay, patient safety indicators, hospital-acquired conditions, and other coding-sensitive measures.
  • Affirm opportunities to improve data integrity through accurate code assignment and documentation interpretation.
  • Support coding-related initiatives that impact organizational quality performance and external reporting.

• Operational Improvement & Workflow Optimization:

  • Partner with Coding Operations and leadership to identify workflow efficiencies and process improvement opportunities.
  • Provide recommendations regarding coding work queues, system edits, automation opportunities, workflow design, and operational controls.
  • Assist in developing and monitoring coding quality metrics, dashboards, and performance indicators.
  • Participate in enterprise projects related to coding quality, compliance, education, and operational effectiveness.
  • Evaluate trends and provide recommendations to improve productivity, accuracy, and consistency.

• Leadership Support & Consultation:

  • Serve as a coding subject matter expert for inpatient coding-related questions and initiatives.
  • Provide consultative support to leadership regarding coding trends, audit findings, education needs, and performance improvement opportunities.
  • Aid leaders with action planning, performance monitoring, and implementation of corrective actions when appropriate.
  • Support organizational readiness for coding guideline updates, regulatory changes, and system implementations.

• Compliance & Regulatory Support:

  • Promote adherence to Official Coding Guidelines, Coding Clinic guidance, payer requirements, and organizational policies.
  • Afford assistance with coding compliance reviews and remediation activities.
  • Maintain current knowledge of regulatory changes, coding updates, and industry best practices.
  • Support audit preparedness and coding compliance initiatives across the organization.

Qualifications

• Required Qualifications:

  • Associate's degree in Health Information Management or related field (Bachelor's preferred).
  • RHIA, RHIT, CCS, or equivalent credential required.
  • 5 years of progressively responsible inpatient coding experience.
  • 2 years of coding quality, auditing, education, mentoring, or leadership experience.
  • Advanced knowledge of ICD-10-CM/PCS, MS-DRG assignment, Official Coding Guidelines, Coding Clinic, and reimbursement methodologies.

• Preferred Qualifications:

  • 7–10 years of inpatient coding experience.
  • Experience onboarding and mentoring coders.
  • Experience conducting coding audits and developing education plans.
  • Experience supporting quality reporting methodologies (Vizient, Elixhauser, PSI/HAC, SOI/ROM, mortality, expected LOS).
  • Experience with Epic, Solventum/3M, encoder and auditing platforms.
  • Leverage of Lean, process improvement, or project management experience.

Skills

• ICD-10-CM/PCS proficiency.
• MS-DRG assignment expertise.
• Official Coding Guidelines understanding.
• Coding Clinic advice familiarity.
• Reimbursement methodologies comprehension.
• Collaboration and teamwork skills.
• Problem-solving and analytical skills.
• Communication and presentation skills.
• Project management and workflow optimization skills.

Benefits

Mass General Brigham offers a comprehensive benefits package, including:

• Health insurance
• Vision and dental coverage
• Retirement savings plan
• Flexible spending accounts
• Employee assistance program
• Telemedicine services
• Wellness programs
• Professional development opportunities
• Generous paid time off

Pay

$63,648.00 - $92,570.40/Annual

Schedule

Day Shift