Inpatient Coding Quality Specialist

Job Summary

Responsible for monitoring, assessing, and improving the quality of coding processes, documentation, and adherence to coding guidelines and regulations by enhancing coding accuracy, minimizing errors, and promoting coding compliance.

Essential Functions

• Develop and implement coding quality assurance programs to evaluate the accuracy, completeness, and compliance of medical coding practices.
• Ensure coding practices align with official coding conventions, guidelines, and regulatory requirements set forth by organizations such as the American Medical Association (AMA), Centers for Medicare and Medicaid Services (CMS), and other relevant bodies.
• Analyze medical records, physician notes, and other relevant documentation to assess the adequacy and specificity of documentation supporting the assigned codes.
• Develop and deliver coding education and training programs to coders, physicians, and other healthcare professionals to enhance coding knowledge, documentation practices, and coding accuracy.
• Identify opportunities to streamline coding workflows, enhance efficiency, and improve coding accuracy.
• Establish key quality metrics and reporting mechanisms to monitor and track coding accuracy, productivity, and compliance.
• Foster effective communication and collaboration with healthcare providers, coders, billing staff, and other stakeholders to address coding-related inquiries, clarify documentation requirements, and resolve coding issues.

Qualifications

• Education: Associate's Degree in Medical Billing and Coding required.
• Experience: 5+ years of medical coding experience required. 1+ years of quality assurance experience preferred.
• Knowledge: Strong inpatient coding experience, academic facility preferred. Must have ICD-10 PCS coding experience.
• Skills: Advanced knowledge of medical coding systems, including ICD-10, CPT, and HCPCS, and their application in hospital billing. Knowledgeable of coding guidelines and regulations, including those set by the AMA, CMS, and other relevant organizations. Strong analytical skills and attention to detail to accurately interpret medical documentation and assign appropriate codes. Excellent understanding of anatomy, physiology, medical terminology, and disease processes to support accurate coding. Excellent communication skills, both written and verbal, to interact effectively with healthcare providers and billing staff. Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.

Additional Job Details (if Applicable)

Remote Type: Remote Work Location: 399 Revolution Drive Scheduled Weekly Hours: 40 Employee Type: Regular Work Shift: Day (United States of America) Pay Range: $30.60 - $44.51/Hourly Grade: 6

At Mass General Brigham

We believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth.