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The Public Provider Reimbursement (PPR) Department within the Center for Health Care Finance Solutions conducts statewide business services for several health and human services agencies of the Executive Office of Health and Human Services (EOHHS) to maximize revenue for the Commonwealth of Massachusetts. Revenue is obtained from private, state and federal resources to reimburse the Commonwealth for the costs of health care and related services provided by public institutions and community-based programs. Under the general supervision of the Senior Manager or designee, the Medical Coding Manager is responsible for supervising, reviewing and if necessary, performing inpatient and outpatient medical coding work and staff at multiple sites to be used for federal claiming purposes.

• Manages, assigns, and prioritizes medical coding workload for high volume inpatient, outpatient and ancillary services including medical, behavioral health, intensive care, surgical and other specialty services for two departments of public health hospitals.
• Leads and manages day-to day activities of the medical coding staff including resolving problems and answering questions from staff promptly.
• Monitors the accuracy and as needed, provides guidance with the assignment of the appropriate ICD-10 (or its successor) diagnosis and procedure codes for inpatient and outpatient services including concurrent ICD codes for ancillary services.
• Monitors the accuracy and as needed, provides guidance with the assignment of the appropriate CPT-4 (or its successor), ICD diagnosis and procedure codes for inpatient, outpatient or ancillary services.
• Oversees and verifies the accuracy of research, analysis, and re-coding of national medical necessity (NCD) denials and local medical review (LMRP) denials for Medicare patients performed by coding staff.
• Conducts concurrent CPT code review of inpatient initial E&M services and shared visits.
• Oversees the completion of concurrent CPT coding reviews for various outpatient clinics.
• Monitors the accuracy and as needed, provides guidance of CPT code assignment by coding staff for “Other” procedures on the Outpatient Encounter Forms.
• Manages quarterly reviews of external auditor of the inpatient MS-LTC-DRG assignment by the inpatient coders. Provide as needed education to inpatient coders for any issues identified during review.
• Maintains and distributes the most current coding information and implement operational changes as needed.
• Responsible for the supervision and training of staff to include hiring, firing and evaluating/documenting performance.
• Write, review, prepare and maintain business documents including reports, contracts, manuals, procedures and presentations.
• Manages employee access and system updates for encoder product and coding reference software portal.
• Develops and implements controls to monitor the quality of coding and coding reviews performed by staff.
• Participates in and coordinates professional training for staff as necessary.
• Participate in continuous quality improvement initiatives and projects.
• Fosters compliance with state and federal rules and regulations.
• Works independently, as a team member and leader.
• Preserves confidential, protected health and personally identifiable information and files.
• Performs other duties as assigned.

REQUIRED EDUCATION
Bachelor’s Degree in medical terminology or related field; or equivalent.
Certified Professional Coder (CPC), or Certified Inpatient Coder (CIC), or Certified Outpatient Coder (COC).

REQUIRED WORK EXPERIENCE
5-7 years of medical coding experience to include at least three years of supervisory or managerial experience.
Comprehensive knowledge of regulatory requirements, including HIPAA.
Strong knowledge of current healthcare and medical terminology, including ICD-10 and CPT-4 codes.
High degree of organization and strong attention to detail.
Strong management and leadership skills and experience.
Ability to communicate, problem solve, and assign work effectively.
Strong experience with multiple specialty coding including but not limited to Cardiology, GI, Oncology, and Orthopedics.
Excellent customer service, written and verbal communication skills.
Demonstrated ability to prioritize and coordinate multiple tasks and meet deadlines.


PREFERRED WORK EXPERIENCE
Knowledge of state and federal rules and regulations related to health care finance.
Strong Microsoft Office Suite skills.
Experience with MEDITECH Health Information System or comparable system
Coding Certification in Inpatient and Outpatient services

-This Manager position covers two sites: Lemeul Shattuck and Tewkbury Hospitals under the     Department of Public Health

- Work site: Lemuel Shattuck Hospital, Jamaica Plain

- Hybrid work - some on-site, some work from home.  Split to be determined at time of hire.

- Some travel to supervise staff and attend management meeting may be required once it is safe.

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