Outpatient Coder II

UMass Memorial Health; Worcester (MA); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Signing bonus

Job summary

UMass Memorial Health is seeking a skilled medical coder to interpret clinical and diagnostic documentation and assign accurate ICD-CM and CPT codes for outpatient and hospital encounters. You will ensure documentation supports codes, participate in audits, and maintain high productivity while adhering to CMS and industry guidelines.

Candidates should hold high school certification with medical coding credentials (CCS/CCS-P preferred) and demonstrate strong communication, organization, and

Qualifications

• Knowledge of ICD-CM (current edition) and CPT coding systems.
• Experience with third-party payer requirements and federal/state guidelines.
• Strong interpersonal, communication and organizational skills.

Responsibilities

• Review medical records to determine correct ICD-CM and CPT codes and modifiers.
• Verify documentation supports codes assigned.
• Assist in resolving missing chart documentation to expedite coding and billing.
• Participate in coding audits and performance management.
• Maintain coding accuracy and productivity per department policies.
• Participate in training and updates on new regulations and coding guidelines.
• Communicate backlog or documentation issues to Manager.
• Refer unusual situations to Manager for guidance.
• Alert management to coding irregularities and trends.
• Adhere to AHA, AMA and CMS regulations.

Skills

ICD-CM CPT knowledge

Interpersonal communications

Organizational skills

Independent work

Problem solving

Ability to meet productivity standards

Education

High School diploma or equivalent

Medical coding certification

CCS or CCS-P certification

Job description

Are you an internal caregiver, student, or contingent worker/agency worker at UMass Memorial Health?

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.
• Good interpersonal and communications skills and demonstrates professionalism
• Good customer service skills with the ability to communicate efficiently.
• Good organizational skills with attention to detail.
• Ability to work independently within established guidelines.
• Ability to organize and coordinate multiple functions and tasks.
• Ability to problem solve, organize and prioritize workload to meet productivity benchmarks.
• Ability to withstand significant level of on-going pressure, and ability to deal with individuals with tact, discretion and diplomacy.

Preferred: Three (3) years of medical abstraction and outpatient coding experience or related work experience

Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.

Department-specific competencies and their measurements will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with position incumbents.

Primary focus is coding Emergency Medicine encounters for the technical and professional side. Evaluation and Management coding experience preferred.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We're striving to make respect a part of everything we do at UMass Memorial Health - for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at [e-mail]. We will make every effort to respond to your request for disability assistance as soon as possible.