Coding Specialist II, Professional Billing

UMass Memorial Health•Worcester, MA

2d•$24 - $40•Onsite

About The Position

Responsible for interpreting medical record data in order to process physician and/or facility charges. Assigns appropriate ICD-CM (current edition) and CPT codes and modifiers as appropriate. Individual Departments, (Emergency Medicine, Trauma Center, Endoscopy Suite, PBCBO, HIM, etc.) will have unique procedures, processes and/or focus, so responsibilities and tasks can differ depending on departmental needs. However, many of the core tasks, required experience and qualifications are similar among all Coding Specialists.

Requirements

High School education, plus medical coding certification.
Three years of medical abstraction and coding experience or related work experience.
Knowledge of ICD-CM (current edition) and CPT, HCPCS coding systems, 3rd party payer requirements and federal/state guidelines and regulations pertaining to coding and billing practices.
Requires intermediate level computer skills with the ability to use standard office software applications, such as Microsoft Office Excel and Word.
Requires good interpersonal and communications skills and demonstrates professionalism when working with team members, management and other staff members.
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.

Nice To Haves

Training in medical terminology from an accredited program. Recognized programs include: AHIMA, NHA, and AAPC.

Responsibilities

Performs analysis on medical record documentation to include review of tests/reports, and determines appropriate codes, as defined by coding guidelines and other recognized reference materials.
Abstracts and enters all codes and required demographic information into the UMMHC computer system, the hospital’s abstracting database, or onto encounter forms, where necessary.
Assists in resolving incomplete and missing chart documentation in order to expedite chart abstraction and billing.
May participate in improvement efforts and documentation training for medical and clinical staff as it relates to coding practices and guidelines.
May participate in quality assurance and performance measurement reviews and reporting.
Informs supervisor when backlog situations arise or necessary documents are either incorrect or are not being received in a timely manner.
Alerts management to any coding irregularities or trends contrary to policy/procedure so that corrective measures can be taken.
Maintains direct and ongoing communications with other coding and billing personnel to maximize overall effectiveness and efficiency of the operation.
Completes patient’s abstracts mandated by Federal and State regulatory agencies, Physician Peer Review, and hospital planning for optimal facility utilization (i.e. Determination of Need, Quality Assurance, research studies and Utilization Review Program).