Job Summary:

• Codes data from inpatient records utilizing a computerized coding system and medical records in paper or electronic format.
• Accurately selects the appropriate diagnoses and procedures to reflect patient care for hospital reimbursement, research, education, and quality assurance.
• Codes and enters data timely by meeting productivity standards.
• Meets productivity standards for inpatient, outpatient or ED medical records.
• Accurately codes and enters into computer system medical data from the medical record utilizing the computerized abstracting system to compile accurate and timely statistical data.
• Understands and follows query process.
• Upon completion of coding, appropriately refers chart for 2nd level review.
• Responsible for accurate documentation and maintenance of the productivity log.
• Assists in the care and maintenance of the department’s equipment and supplies.
• Audits patient records and maintains records
• Performs medical record audits
• Performs other departmental duties and functions

Skills on Resume: 

• Medical Coding Proficiency (Hard Skills)
• Attention to Detail (Soft Skills)
• Timeliness (Soft Skills)
• Knowledge of Coding Systems (Hard Skills)
• Query Process Understanding (Hard Skills)
• Review and Audit Skills (Hard Skills)
• Documentation and Maintenance (Hard Skills)
• Departmental Support (Soft Skills)

Job Summary:

• Identify all billable services requiring professional fee billing
• Abstract pertinent details from reports/records and assign CPT, CDT and ICD codes to ensure accurate and timely reimbursement. 
• Requires a proficient and competent understanding of medical terminology and anatomy to assist in selection of appropriate procedure and diagnosis codes.
• Review documentation of services for evidence of and level of attending physician personal involvement for Medicare patients. 
• Assure that entries in the electronic health record reflect proper documentation and coding standards for quality control and conformance with Medicare, Medicaid, and other pertinent rules and regulations.
• Contact responsible providers in a professional, tactful manner, if coding clarification
• Maintain up-to-date knowledge of coding principles and guidelines
• Maintain a working knowledge of Centers for Medicare and Medicaid Services (CMS) and insurance/payer guidelines to assure use of correct coding policies and guidelines.
• Maintain a strong working knowledge of Correct Coding Initiative (CCI) edits.
• Serve as a key information resource and respond to queries associated with coding and related billing issues.
• Participate in continuing education to stay current with coding changes, additions, deletions, and updates as necessary.
• Maintain a strong working knowledge of axiUm and MINDSCAPE/ORCA.

Skills on Resume: 

• Medical Coding Expertise (Hard Skills)
• Regulatory Compliance (Hard Skills)
• Attention to Detail (Hard Skills)
• Communication Skills (Soft Skills)
• Coding Principles and Guidelines (Hard Skills)
• Software Proficiency (Hard Skills)
• Quality Control (Hard Skills)
• Continuing Education (Hard Skills)

Job Summary:

• Participates in ongoing quality control programs that include the following such as reviews with Data Quality Specialists, Technical Advisors and/or 3rd party vendors. 
• Update accounts and adhere to any remediation programs established for areas of deficiency.
• Recognizes and understands the role of a coder in the department and how it relates to the overall function of the hospital regarding patient care, quality reporting case mix index and reimbursement methodologies.
• Proactively practices departmental and hospital confidentiality policies and procedures. 
• Responsible for performing any and all other assigned duties as requested.
• Recognizes and understands the role of a coder in the department and how it relates to the overall function of the hospital regarding patient care, case mix, and fiscal reimbursement
• Attends department staff meetings and other Mass General Brigham and Revenue Cycle Operations meetings as directed.
• Participates and completes department-sponsored workshops and continuing education programs germane to clinical processes and coding.
• Works with physician practice staff through the Practice Management System’s tasking function to obtain the necessary documentation prior to following up and submitting claims that require referrals, records, or additional information.
• Participates in meetings and on committees and represents the department and hospital in community outreach efforts.Participates in multi-disciplinary quality and service improvement teams.

Skills on Resume: 

• Data Quality Management (Hard Skills)
• Account Management and Remediation (Hard Skills)
• Understanding of Coding and Hospital Functions (Hard Skills)
• Confidentiality and Compliance (Soft Skills)
• Adaptability and Task Management (Soft Skills)
• Engagement in Meetings and Continuing Education (Soft Skills)
• Collaboration with Physician Practice Staff (Soft Skills)
• Community and Quality Improvement Involvement (Soft Skills)

Job Summary:

• Performs coding function through review and analysis of electronic, paper, or hybrid patient medical records and assigning diagnosis and procedure codes through ICD-9-CM, ICD-10-CM, ICD-10-PCS as of 1-1-2014, and CPT-4 coding and classification systems.
• Queries physicians when additional documentation is needed for coding specificity.
• Works with DRGs and APR-DRGs.
• Abstracts clinical data from these same patient records and performs data entry into clinical/statistical database.
• Processes and maintains accurate hospital statistics.
• Reviews EPIC work queues daily for coding edits and makes necessary and appropriate coding changes based on medical documentation.
• Conducts reviews for appeals from payor denials.
• Processes infusion and injection coding on observation and treatment patients.
• Works as a collaborative team member with Revenue Cycle Department, Quality Service Department and Finance Department to ensure optimization of reimbursement.
• Assists with research projects by working with physicians and other requestors and querying pertinent databases or indices for reportable statistics such as diagnoses, procedures, and/or physicians.

Skills on Resume: 

• Medical Coding Proficiency (Hard Skills)
• Clinical Data Abstraction (Hard Skills)
• Coding Accuracy and Compliance (Hard Skills)
• DRG and APR-DRG Knowledge (Hard Skills)
• Query and Documentation (Hard Skills)
• Statistical Reporting (Hard Skills)
• Collaborative Teamwork (Soft Skills)
• Appeals and Denial Management (Hard Skills)

Job Summary:

• Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations.
• Answers the telephone with a positive and professional tone of voice
• Identifies and answers coding questions professionally and appropriately to ensure each call is handled in a timely and efficient manner.
• Assists physicians, patient and insurance representatives, procedure schedulers, and managers by identifying problem billing patterns and answering questions regarding coding to ensure each cal and/or denial is handled efficiently.
• Assists with periodic audit/research of problems pertaining to coding by reviewing submitted claims, denials, and reimbursements to ensure maximum reimbursement from payors.
• Initiates correspondence to and answers rejections from insurance companies regarding patient accounts and claim appeals by following established insurance protocols.
• Maintains a regulatory/compliance environment by following organizational policies and procedures to ensure compliance to state, local, and federal standards and regulations.
• Obtains and maintains the most current coding information for appropriate payors
• Communicate any policy changes with AR management and team members.
• Obtains, communicates and initiates correspondence with insurance companies to resolve coding discrepancies to ensure maximum reimbursement from payors.
• Receives insurance denials and requests and reviews patients’ medical records to resubmit claims using accurate ICD-10 and CPT codes and following professional coding standards to ensure maximum reimbursement from payors.
• Reviews and assists with hospital charge processing by using accurate ICD-10 and CPT codes and following professional coding standards to ensure maximum reimbursement from payors.

Skills on Resume: 

• Professional Communication (Soft Skills)
• Coding Expertise (Hard Skills)
• Problem Solving (Soft Skills)
• Regulatory Compliance (Hard Skills)
• Audit and Research Skills (Hard Skills)
• Insurance Claims Management (Hard Skills)
• Attention to Detail (Soft Skills)
• Adaptability to Policy Changes (Soft Skills)

Job Summary:

• Analyzes medical information documented in medical records 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-related claim edits.
• 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
• Completes coding, charging and/or 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.
• Utilizes available coding-related resources and references to research and support coding decisions and seeks input from department subject matter experts
• 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.
• Requests clarification for incomplete, illegible, contradicting, or unclear documentation either directly or through the Data Quality Specialist for Clinical Documentation Specialist.
• Monitor and update coding queues
• Maintain coding production quotas and 95% coding accuracy rate.
• Update and process coding tracking queues in a timely matter
• May perform the work of lower level classifications of the Coding Specialist series.

Skills on Resume: 

• ICD-10-CM and CPT-4/HCPCS Coding Proficiency (Hard Skills)
• Official Coding Guidelines and Standards Knowledge (Hard Skills)
• Training and Workflow Management (Soft Skills)
• Coding and Claim Edit Resolution (Hard Skills)
• Coding Resources Utilization (Hard Skills)
• Understanding of Payment Systems (Hard Skills)
• Documentation Clarification and Issue Resolution (Soft Skills)
• Coding Accuracy and Queue Management (Hard Skills)