Coding Specialist, Pain Management

Mass General Brigham•Somerville, MA

9d•Remote

About The Position

Responsible for reviewing patient medical records after a visit and translating the information into codes that insurers use to process claims from patients. Duties include confirming treatments with medical staff, identifying missing information and submitting information to insurers for reimbursement. Participates in peer review to ensure accuracy and timeliness standards are maintained. Resolve complex coding questions that arise from team. Evaluates medical record documentation and coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflect and support outpatient visits and to ensure that data complies with legal standards and guidelines. Interprets medical information such as diseases or symptoms and diagnostic descriptions and procedures to accurately assign and sequence the correct ICD-9-CM and CPT codes. Provides technical guidance to physicians and other staff in identifying and resolving issues or errors such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, and/or codes that do not conform to approved coding principles/guidelines. Manages complex coding situations and supports peers through challenging questions. Peer reviews records for management to ensure accuracy of information. Audits clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes. Researches, analyzes, recommends, and facilitates plan of action to correct discrepancies and prevent future coding errors. Identifies reportable elements, complications, and other procedures.

Requirements

High School Diploma or Equivalent required
Medical Coding Experience 2-3 years required
In-depth knowledge of medical coding systems, including ICD-10, CPT, and HCPCS, and their application in hospital billing.
Strong understanding of coding guidelines, regulations, and industry best practices.
Strong communication and interpersonal skills to effectively collaborate with healthcare providers, coders, and other stakeholders.
Strong problem-solving skills to address coding-related challenges and implement effective solutions.
Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.

Nice To Haves

Associate's Degree Medical Billing and Coding preferred
Excellent leadership and team management skills, with the ability to motivate and develop coding team members.

Responsibilities

Reviewing patient medical records after a visit and translating the information into codes that insurers use to process claims from patients.
Confirming treatments with medical staff.
Identifying missing information and submitting information to insurers for reimbursement.
Participating in peer review to ensure accuracy and timeliness standards are maintained.
Resolving complex coding questions that arise from team.
Evaluating medical record documentation and coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflect and support outpatient visits and to ensure that data complies with legal standards and guidelines.
Interpreting medical information such as diseases or symptoms and diagnostic descriptions and procedures to accurately assign and sequence the correct ICD-9-CM and CPT codes.
Providing technical guidance to physicians and other staff in identifying and resolving issues or errors such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, and/or codes that do not conform to approved coding principles/guidelines.
Managing complex coding situations and supporting peers through challenging questions.
Peer reviewing records for management to ensure accuracy of information.
Auditing clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes.
Researching, analyzing, recommending, and facilitating plan of action to correct discrepancies and prevent future coding errors.
Identifying reportable elements, complications, and other procedures.