Inpatient Coding Quality & Education Specialist

Mass General Brigham•Somerville, MA

2d•$63,648 - $92,570•Remote

About The Position

Mass General Brigham Incorporated Mass 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. About Us: As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women’s Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research. We’re focused on a people-first culture for our system’s patients and our professional family. That’s why we provide our employees with more ways to achieve their potential. Mass General Brigham is committed to aligning our employees’ personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development—and we recognize success at every step. Our employees use the Mass General Brigham values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.

Requirements

Associate's degree in Health Information Management or related field (Bachelor's preferred)
RHIA, RHIT, CCS, or equivalent credential required
5 years of progressively responsible inpatient coding experience
2 years of coding quality, auditing, education, mentoring, or leadership experience
Advanced knowledge of ICD-10-CM/PCS, MS-DRG assignment, Official Coding Guidelines, Coding Clinic, and reimbursement methodologies

Nice To Haves

7–10 years of inpatient coding experience
Experience onboarding and mentoring coders
Experience conducting coding audits and developing education plans
Experience supporting quality reporting methodologies (Vizient, Elixhauser, PSI/HAC, SOI/ROM, mortality, expected LOS)
Experience with Epic, Solventum/3M, encoder and auditing platforms
Lean, process improvement, or project management experience

Responsibilities

Perform pre-bill and post-bill coding audits utilizing internal and third-party audit platforms and vendor software.
Review coded accounts for coding accuracy, reimbursement integrity, quality reporting implications, and compliance with coding guidelines.
Analyze audit findings to identify trends, educational opportunities, and systemic process improvement initiatives.
Collaborate with Coding Operations, Quality, CDI, Revenue Integrity, and Compliance teams to address identified findings and implement corrective actions.
Track, trend, and report audit outcomes to leadership and operational stakeholders.
Support external audit preparedness and validation activities, including payer, regulatory, and vendor reviews.
Lead onboarding and competency development for newly hired inpatient coders or Data Quality Specialist.
Develop and deliver coding education related to ICD-10-CM, ICD-10-PCS, Official Coding Guidelines, Coding Clinic advice, regulatory updates, and organizational policies.
Create educational materials, tip sheets, job aids, presentations, and learning resources.
Facilitate individual and group education sessions based on audit findings, quality trends, and operational needs.
Support ongoing professional development and coding competency initiatives.
Collaborate with quality, CDI, and operational teams to evaluate coding impacts on quality reporting and benchmarking methodologies.
Analyze coding opportunities affecting Vizient, Elixhauser, mortality, severity of illness, risk of mortality, expected length of stay, patient safety indicators, hospital-acquired conditions, and other coding-sensitive measures.
Assist in identifying opportunities to improve data integrity through accurate code assignment and documentation interpretation.
Support coding-related initiatives that impact organizational quality performance and external reporting.
Partner with Coding Operations and leadership to identify workflow efficiencies and process improvement opportunities.
Provide recommendations regarding coding work queues, system edits, automation opportunities, workflow design, and operational controls.
Assist in developing and monitoring coding quality metrics, dashboards, and performance indicators.
Participate in enterprise projects related to coding quality, compliance, education, and operational effectiveness.
Evaluate trends and provide recommendations to improve productivity, accuracy, and consistency.
Serve as a coding subject matter expert for inpatient coding-related questions and initiatives.
Provide consultative support to leadership regarding coding trends, audit findings, education needs, and performance improvement opportunities.
Assist leaders with action planning, performance monitoring, and implementation of corrective actions when appropriate.
Support organizational readiness for coding guideline updates, regulatory changes, and system implementations.
Promote adherence to Official Coding Guidelines, Coding Clinic guidance, payer requirements, and organizational policies.
Assist with coding compliance reviews and remediation activities.
Maintain current knowledge of regulatory changes, coding updates, and industry best practices.
Support audit preparedness and coding compliance initiatives across the organization.