Inpatient Coding Quality Specialist, Remote

Partner's Healthcare; Somerville (MA); Remote; USD 43,000 - 62,000; Full time

Job summary

Mass General Brigham Incorporated is seeking a Full-time Coding Quality Assurance Specialist to monitor and improve the quality, accuracy, and compliance of medical coding across departments. You will develop QA programs, align practices with AMA/CMS guidelines, and educate staff to enhance coding accuracy.

The role requires strong ICD-10-PCS proficiency, inpatient coding experience, and the ability to analyze documentation to support correct coding decisions.

Qualifications

• Associate's degree in 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.

Responsibilities

• 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 AMA, CMS, and other relevant bodies.
• Analyze medical records, physician notes, and other documentation to assess coding adequacy and specificity of documentation.
• Develop and deliver coding education and training programs to coders, physicians, and other healthcare professionals to enhance coding knowledge and accuracy.
• Identify opportunities to streamline coding workflows, enhance efficiency, and improve coding accuracy.
• Establish key quality metrics and reporting mechanisms to monitor coding accuracy, productivity, and compliance.
• Foster effective communication with providers, coders, billing staff, and stakeholders to address inquiries and resolve coding issues.

Skills

Medical coding

Quality assurance

Inpatient coding

ICD-10-PCS

Education

Associate's Degree Medical Billing and Coding

Job description

Site: Mass General Brigham IncorporatedMass 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

• EducationAssociate's Degree Medical Billing and Coding required
• Experience5+ years of medical coding experience required
• 1+ years of quality assurance experience preferredStrong 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.

Working Schedule

Full time, 40 hours/week. Monday - Friday, eastern standard business hoursRemote hours require a quiet, secure, HIPAA-compliant working station

Additional Job Details

Remote Type RemoteWork Location 399 Revolution DriveScheduled Weekly Hours 40Employee Type RegularWork Shift Day (United States of America)Pay Range $30.60 - $44.51/HourlyGrade 6At Mass General Brigham

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.

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.