Coding Quality Specialist

About Us
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.
The Opportunity
Under general supervision of the Coding Manager in the Coding Operations Revenue Cycle Operations department, the Teammate is responsible for:

• Post coding, pre-billing review of inpatient medical records (based on system identified sample) to verify the accuracy of assigned ICD-10 -CM/PCS and/or CPT-4 codes and DRGs as required.
• Assists with development of proactive studies to assess Coding Quality in selected sub-populations.
• Serves as CDI & Quality liaison to discuss questions regarding ICD-10 code and/or DRG assignment.
• Responsible for retrospective coding queries to clinical staff.
• Makes recommendations to Coding Manager regarding specific in-service education needs of staff.

Principal Duties and Responsibilities:

• Using the inpatient pre-bill auditing tool, reviews selected medical records to analyze for correct code and DRG assignment based on edits identified by the inpatient pre-bill auditing tool. Interacts with Coding Specialist to discuss the records and offer advice and education as to how to improve Coding Quality.
• Using the inpatient pre-bill auditing tool identifies PSI (Patient Safety Indicator) and HAC (Hospital Acquired Conditions) and works collaboratively with the Quality Departments in assuring that coding/DRG assignment correctly reflects the care provided to the patient.
• Under the guidance of Coding Manager, performs quality assessment of departmental Coding Quality through statistically valid sampling techniques. Develops reports of error thresholds, error rates and their causes.
• Research online and print resources and submits questions to 3M Nosology and Coding Clinic as directed in order to provide Coding Managers and other groups with recommendations for department and enterprise coding guidance.
• Communicates with medical staff regarding retrospective coding queries.
• Enters appropriate retrospective query information for tracking within Epic abstracting tool.
• Identifies and documents positive and negative coding trends through daily interaction with Coding Specialists. Reports all findings to the Coding Manager and communicates with Coding Specialists as necessary.
• Plans and carries through to completion proactive studies to assess Coding Quality in selected sub-populations. Researches and analyzes studies that have been prepared by government and professional associations.
• Provides recommendations for education to Coding Specialists, physicians and CDI and Quality Departments as appropriate.
• Assists in training employees or contract coders in specific coding guidance, policies and procedures and computer systems.
• Assists in training Coding Specialist Trainees in general coding guidelines and decision-making. Reviews 100% of trainee records until such time that a satisfactory level of quality has been attained.
• May be asked to assist in the review of all insurance audit DRG and RAC determination letter proposed changes and assists in the writing of appeals for all invalid changes citing supporting medical record documentation and appropriate official coding guidelines.
• May be asked to enter appropriate audit information into audit tracking system.
• Assists and provides SME in resolving coding related billing questions that relate to specific cases.
• Assists in providing SME in resolving coding questions from other areas.
• Proactively practices departmental and hospital confidentiality policies and procedures.
• May participate in hospital-sponsored workshops and continuing education programs germane to clinical processes and specific coding issues.
• Has a complete understanding of all related coding systems and can function as a system super-user as required.
• Performs special projects and other related duties as assigned by the Coding Manager

Qualifications
Qualifications:
EDUCATION: AS/BS in Health Information Technology/Administration OR CCS with significant coding experience required. College level courses in medical terminology, biology, anatomy and physiology, basic pathology, ICD-10-CM/PCS and CPT coding are required.
EXPERIENCE: At least 3 years of ICD-10-CM/PCS and CPT-4 coding experience in an acute care setting required. Experience at an academic medical center preferred.
CERTIFICATION: RHIA, RHIT or CCS by AHIMA or appropriate APPC credentialing required. CCS eligible may be considered with significant coding experience but CCS credential may be considered but would require certification within 1 year of hire.
Must maintain AHIMA and/or AAPC credentialing by meeting or exceeding requirement Continuing Education Requirements and passing annual coding test required as part of continued credentialing maintenance.
Skills/Abilities/Competencies Required:

• Team leader, have excellent verbal, written and interpersonal skills.
• Ability to provide subject matter expertise (SME) as required.
• In depth and up-to-date knowledge and understanding of anatomy and physiology, medical terminology, pathophysiology and pharmacy in order to read, analyze and code the medical record.
• In-depth knowledge of ICD-10 CM and PCS and CPT-4 coding principles and conventions.
• In-depth knowledge of reimbursement methodologies.
• Ability to communicate and work effectively with physicians and other professional staff.
• Current knowledge of coding reference materials; e.g. AHA Coding Clinic, AMA CPT Assistant, etc.
• Accurate data entry and retrieval skills in multiple computer systems.
• Proficient in Microsoft Office products especially WORD, EXCEL and PowerPoint.

Working Conditions:
100% Remote position; requires all work done on computer or by telephone and is 100% sedentary. Organization provides equipment; employee responsible for WIFI and telephone connections.
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 the law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, perform essential job functions, and receive other benefits and privileges of employment.