Senior Outpatient Coder

Community Care Cooperative • Boston, MA

8d • $57,000 - $66,975 • Hybrid

About The Position

The Senior Certified Outpatient Coder will be a part of an emerging coding team under the billing and credentialing service that performs coding review for FQHCs. The Outpatient Coder will report to Director of Revenue Integrity and is responsible for performing coding audits on ambulatory medical records for multi-specialty provider organizations to ensure billed codes are accurately supported by the clinical documentation. The Senior coder will ensure accurate diagnosis and procedure coding, as well as providing documentation and coding related feedback to providers and coders. Responsible for interpreting medical record data in language that the payers can interpret in order to process physician charges, and is compliant with all coding guidelines.

Requirements

• Knowledge of ICD-CM (current edition) CPT, HCPCS coding systems as well as CCI edits
• Knowledge of third-party payer requirements, federal and state guidelines and regulations on medical coding and billing
• Knowledge and understanding of current ICD-10-CM and CPT/HCPC Official Guidelines for Coding and Reporting
• Knowledge of medical records content and management
• Knowledge of teaching physician regulations, including incident to, split shared and attestation requirements
• Experience conducting coding related audits for coding accuracy and quality
• Experience providing education to providers and clinical staff on coding documentation
• Working knowledge of the Epic EMR either through experience or education
• Medical terminology
• Knowledge of laws and regulations about health information and patient confidentiality
• Proficient in Microsoft office applications such as Excel, Word and PowerPoint
• Demonstrating flexibility with respect to changing end-user business needs
• Good interpersonal and communications skills and demonstrates professionalism when working with team members, management and other staff members.
• The ability and willingness to take ownership of work activities and ensure that they are completed in an accurate, efficient, and timely manner
• The ability and willingness to learn new software and systems
• Ability to determine a problem’s cause and developing a course of action to resolve the problem and to prevent its recurrence
• The ability to persevere in difficult situations and overcome obstacles
• Must be able to remain in a stationary position 50-75% of the time

Nice To Haves

• Familiarity with the MassHealth ACO program
• Familiarity with Federally Qualified Health Centers
• Experience with anti-racism activities, and/or lived experience with racism is highly preferred

Responsibilities

• Serves as an expert on coding guidelines
• Assigns appropriate diagnosis codes (ICD-10) and procedure codes (CPT/HCPCS) to patient encounters based on medical documentation, physician notes, and other information
• Ensures all coding is completed in a timely manner to meet billing deadlines
• Communicate with healthcare providers to clarify coding questions and concerns
• Participates in improvement efforts and documentation training for medical and clinical staff
• Recommend improvements to workflows in Epic to facilitate accurate documentation
• Stay abreast of coding and documentation guidelines, compliance policies, annual coding updates, payer policies and industry changes
• Conduct regular audits to monitor coding accuracy and identify areas for improvement or education to coding staff
• Performs Denial analysis to identify trends related to coding
• Identify coding/documentation trends that may pose a risk to revenue stream and report such trends to management team
• Continuously improve coding processes and contribute to the overall success of the team
• Provide recommendations to manager for the most efficient utilization of assigned personnel
• Acts as department resource for special projects and coding related questions and issues
• All other duties as assigned

Benefits

• In compliance with Infection Control practices per Mass.gov recommendations, we require all employees to be vaccinated consistent with applicable law.

What This Job Offers

• Career Level: Senior
• Education Level: High school or GED