Outpatient Coder II

UMass Memorial Health•Worcester, MA

8d•$24 - $35

About The Position

Interprets clinical and diagnostic documentation to process hospital and/or professional-fee charges for outpatient care. Reviews medical records, tests, and reports to assign appropriate current-edition ICD-CM and CPT codes and modifiers; depending on account type, may also assign ICD-PCS codes according to official coding guidelines and recognized reference materials. Verifies that documentation supports assigned codes and helps resolve incomplete or missing chart documentation to expedite coding and billing. The position participates in coding audits and performance management, maintains a coding accuracy rate of at least 95% and department productivity standards, and stays current with coding regulations and updates through required training. It communicates with coding personnel and management about backlogs, missing or incorrect documents, unusual situations, coding irregularities, and trends requiring corrective action. The role also supports improvement efforts and documentation training for medical and clinical staff, and follows coding and billing regulations established by the AHA, AMA, and CMS. This is a non-exempt position scheduled Monday through Friday, 7:00 a.m. to 3:30 p.m., for 40 hours per week. The listed hiring range is $23.81–$35.08, with final compensation dependent on scheduled hours, experience, skills, qualifications, and internal equity. A signing bonus may be available, subject to eligibility confirmation during the interview process. The position is represented by SHARE (State Healthcare and Research Employees).

Requirements

High school diploma or equivalent.
Knowledge of current-edition ICD-CM and CPT coding systems and CCI edits.
Knowledge of third-party payer requirements and federal and state guidelines and regulations related to coding and billing.
Good interpersonal and communication skills, with professionalism.
Good customer service skills and the ability to communicate efficiently.
Good organizational skills and 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 ongoing pressure and deal with individuals tactfully, discreetly, and diplomatically.

Nice To Haves

Medical coding certification.
Training in medical terminology from an accredited program, with completion and passing of a certification program within one year of hire; recognized programs include AHIMA and AAPC.
Certified Coding Specialist (CCS) or Certified Coding Specialist–Physician (CCS-P) certification.
Three years of medical abstraction and outpatient coding experience or related work experience.

Responsibilities

Review medical records, tests, and reports to determine appropriate current-edition ICD-CM and/or CPT codes and modifiers; assign ICD-PCS codes when appropriate for the account type.
Verify that documentation is present to substantiate assigned codes.
Assist in resolving incomplete or missing chart documentation to expedite coding and billing.
Participate in the continuous coding audit and performance management program.
Maintain a coding accuracy rate of at least 95% and meet department productivity standards.
Attend required training classes and coding in-services to stay current with regulations and coding guidelines.
Participate in improvement efforts and provide documentation training to medical and clinical staff related to coding practices and guidelines.
Notify the Manager of backlogs or documents that are incorrect or not received in a timely manner.
Refer unusual or questionable situations to the direct Manager.
Alert management to coding irregularities or trends contrary to policies and procedures.
Follow coding and billing regulations established by the AHA, AMA, and CMS.
Maintain ongoing communication with other coding personnel to support operational effectiveness and efficiency.
Keep current with coding updates and information related to correct coding.
Comply with departmental policies, procedures, objectives, and health and safety requirements.
Attend meetings, conferences, and seminars as required or directed.
Demonstrate use of quality improvement in daily operations.
Maintain regular, reliable, and predictable attendance; perform other similar and related duties as required or directed.
Demonstrate professionalism and respect for diverse views, and contribute to a respectful and inclusive environment for employees, patients, and visitors.