Outpatient Coder II

ummh; Worcester (MA); On-site; USD 54,000 - 78,000; Full time

Benefits offered by this job

Signing bonus available

Job summary

UMass Memorial Health in Worcester, MA seeks a skilled Medical Coder to interpret clinical and diagnostic documentation and assign ICD-CM and CPT codes for outpatient episodes. You will ensure documentation supports codes and assist in optimizing reimbursement.

Responsibilities include conducting audits, maintaining coding accuracy above 95%, and staying current with coding guidelines and payer requirements through ongoing training and collaboration with clinical staff.

Qualifications

• Knowledge of ICD-CM (current edition) and CPT coding systems.
• Familiarity with third-party payer requirements and CMS guidelines.
• Ability to interpret clinical documentation to support coding.

Responsibilities

• Interpret clinical and diagnostic documentation to assign ICD-CM and CPT codes.
• Verify documentation supports codes and modifiers as appropriate.
• Assist in resolving missing or incomplete chart documentation to expedite coding and billing.
• Participate in coding audits and performance improvement initiatives.
• Maintain coding accuracy rate of at least 95% and adhere to department policies.
• Keep up-to-date with coding updates and payer requirements; communicate findings to management.

Skills

ICD-CM coding

CPT coding

Payer requirements

Education

High School diploma

Medical coding certification

AHIMA/AAPC training

CCS/CCS-P certification

Job description

Exemption Status: Non-Exempt

Hiring Range: $0.00 - $0.00 Please note that the final offer may vary within this range based on a candidate's experience, skills, qualifications, and internal equity considerations.

Schedule Details:
Monday through Friday
Scheduled Hours: 7a-3:30p
Shift: 1 - Day Shift, 8 Hours (United States of America)
Hours: 40

Cost Center: 99940 - 5470 ED Coding and Revenue Capture

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

Interprets a wide variety of clinical and diagnostic documentation in order to process hospital and / or pro-fee charges for episodes of outpatient care. Assigns appropriate ICD-CM (current edition) and CPT codes as well as modifiers. Based on account type, may assign ICD-PCS codes, as appropriate adhering to official coding guidelines.

I. Major Responsibilities:

1. Upon review of the medical record, performs analysis on documentation, which includes review of tests / reports to determine the appropriate ICD-CM (current edition) and / or CPT codes as well as modifiers. Based on account type, may assign ICD-PCS codes, as defined by official coding guidelines and other recognized reference materials.
2. Verifies documentation is present to substantiate codes assigned.
3. Assists in resolving incomplete and / or missing chart documentation in order to expedite coding and billing.
4. Participates in the continuous coding audit and performance management program.
5. Maintains coding accuracy rate of not less than 95% for optimal reimbursement as well as department productivity standards as outlined in department policies.
6. Attends required training classes and coding in-services each year to stay abreast of new regulations and coding guidelines.
7. Participates in improvement efforts and documentation training for medical and clinical staff as it relates to coding practices and guidelines.
8. Communicates to Manager when backlog situations arise or necessary documents are either incorrect or are not being received in a timely manner.
9. Refers all unusual, questionable situations to the direct Manager.
10. Alerts management to any coding irregularities, or trends contrary to policies / procedures, so corrective measures may be taken.
11. Adheres to the coding and billing regulations established by the American Hospital Association (AHA), American Medical Association (AMA), and Centers for Medicare and Medicaid Services (CMS).
12. Maintains direct and ongoing communications with other coding personnel to maximize overall effectiveness and efficiency of the operation.
13. Keeps current with all coding updates and information related to correct coding.

Standard Staffing Level Responsibilities:

1. Complies with established departmental policies, procedures and objectives.
2. Attends variety of meetings, conferences, seminars as required or directed.
3. Demonstrates use of Quality Improvement in daily operations.
4. Complies with all health and safety regulations and requirements.
5. Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.
6. Maintains, regular, reliable, and predictable attendance.
7. Performs other similar and related duties as required or directed.

All responsibilities are essential job functions.

II. Position Qualifications:

License/Certification/Education:

Required:

• High School diploma or equivalent

Preferred:

• Medical coding certification
• Training in medical terminology from an accredited program, completing and passing certification program within one year from date of hire. (Recognized programs include: American Health Information Management Association (AHIMA) and American Academy of Professional Coders (AAPC).
• Certification as a Certified Coding Specialist (CCS) or Certified Coding Specialist - Physician (CCS-P)

Experience/Skills:

Required:

• Knowledge of ICD-CM (current edition) and CPT coding systems as well as CCI edits
• Knowledge of third-party payer requirements as well as federal and state guidelines and regulations pertaining to coding and billing practices.