Coding Quality Specialist, Inpatient

0100 Mass General Brigham Incorporated; Somerville (MA); Remote; USD 43,000 - 62,000; Full time

Job summary

Mass General Brigham Incorporated is seeking a Coding Quality Assurance professional to monitor, assess, and improve coding processes and documentation accuracy. You will enhance adherence to coding guidelines and ensure compliance with AMA, CMS, and other regulatory bodies.

Responsibilities include developing QA programs, analyzing records for code adequacy, and delivering education to coders and clinicians.

Qualifications

• Education Associate's Degree Medical Billing and Coding required.
• 5+ years of medical coding experience required.
• 1+ years of quality assurance experience preferred.
• Strong inpatient coding experience, academic facility preferred.
• Must have ICD-10 PCS coding experience.
• Knowledge of AMA, CMS guidelines and other relevant organizations.
• Excellent communication skills, both written and verbal, to interact with providers and billing staff.

Responsibilities

• Develop and implement coding quality assurance programs to evaluate accuracy, completeness and compliance of medical coding practices.
• Ensure coding practices align with official coding conventions and regulatory requirements (AMA, CMS).
• Analyze medical records and physician notes to assess documentation supporting codes.
• Develop and deliver coding education and training programs to coders and clinicians.
• Identify opportunities to streamline coding workflows and improve accuracy.
• Establish quality metrics and reporting to monitor coding accuracy and productivity.
• Collaborate with providers, coders, billing staff to address coding inquiries and issues.

Skills

Medical coding knowledge

ICD-10 PCS

Attention to detail

Communication skills

Analytical skills

Documentation interpretation

Independent work

Education

Associate's Degree in Medical Billing and Coding

Job description

Site: Mass General Brigham Incorporated

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

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 Medical Billing and Coding required Experience 5+ years of medical coding experience required 1+ years of quality assurance experience preferred Strong inpatient coding experience, academic facility preferred. Must have ICD-10 PCS coding experience Knowledge, Skills and Abilities 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.

EEO Statement: 0100 Mass General Brigham Incorporated is an Equal Opportunity Employer. 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 law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

Combat disease. Hold a hand. Help people. Impact the world. Mass General Brigham is a passionate, welcoming community where minds meet caring hearts. Come be a part of the world’s most powerful force in medicine, where every role is important in changing lives. Are you ready? Our history includes New England hospitals founded over 200 years ago, some of the first and most prestigious hospitals in the world. Built on the legacy of two leading academic medical centers, we’re more than a system—we’re leaders in the practice of medicine. Mass General Brigham is committed to serving the community. We are dedicated to enhancing patient care, teaching and research, and taking a leadership role as an integrated health care system. We recognize that increasing value and continuously improving quality are essential to maintaining excellence.