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Location: Worcester, MA
Exempt/Non-Exempt: Non Exempt
Business Unit: ForHealth Consulting
Department: ForHealth Consulting - PPR - W407625
Job Type: Full-Time
Salary Grade: 06
Union Code: Non Union Position-W25-Non Unit Classified
Num. Openings: 2
Post Date: Sept. 27, 2023
GENERAL SUMMARY OF POSITION:
Under the general supervision of the Medical Coding Supervisor or designee, the Inpatient Medical Coding Specialist is responsible for assigning diagnosis codes for inpatient services to be used for federal claiming purposes. The Specialist will code and abstract inpatient medical records using the standardized coding system, to include identifying and classifying disease and procedure codes.
- Analyzes medical record documentation, including review of tests and reports, according to coding guidelines to assign the appropriate ICD-10 or CPT-4 codes (or their successors) for all inpatient services including medical, behavioral health, intensive care, surgical or other specialty inpatient services.
- Assigns admitting and principal ICD (or its successor) diagnosis codes for every inpatient admission, including follow up with clinicians on clarification/addendums to documentation for present on admission code
- Assigns appropriate diagnosis codes for discharged patients.
- Performs concurrent ICD diagnosis coding every 60 days.
- Researches, analyzes, and re-codes national medical necessity (NCD) denials and local medical review (LMRP) denials for Medicare patients as appropriate for resubmission.
- Abstracts and enters all codes and required demographic information into the appropriate computer systems and forms.
- Participates in professional training as necessary including ICD-10 training.
- Fosters compliance with state and federal rules and regulations.
- Works independently and as a team member and leader.
- Preserves confidential, protected health and personally identifiable information and files.
- Performs other duties as assigned.
- Associates degree in Medical Terminology or a related field; or equivalent relevant experience
- Three years of inpatient medical coding experience or equivalent relevant experience
- Knowledge of healthcare and medical terminology, including ICD-10 and CPT-4 codes.
- High degree of organization and strong attention to detail.
- Ability to communicate and problem solve effectively.
- Proficient in computer skills and Microsoft Office
- Must maintain current knowledge of coding and billing practices through reading of newsletters, publications and attendance at seminars.
- Completion of credentials of Certified Professional Coder (CPC)
- Knowledge of state and federal rules and regulations related to health care finance
- Ability to plan, prioritize and schedule multiple work tasks
- ICD-10 Certification
About the Health Care Finance Solutions and Public Provider Reimbursement
Health Care Finance Solutions (HCFS) is a part of ForHealth Consulting, the health care operations and consulting division of UMass Chan Medical School, Massachusetts only public medical school. As nationwide leaders in the development and implementation of health care reform, ForHealth and HCFS stay ahead of health care trends and help strategize and plan for changes that impact both health care delivery systems and patients on the local, state, and national level. HCFS helps state and local health and human service agencies, and programs identify opportunities to increase savings and reimbursements through federal and other third party sources, establish effective savings and reimbursement programs, and capitalize on all possible revenue streams. At the same time, we identify opportunities for our clients to increase health care related services, reduce the net cost of delivery, and help ensure individuals receive the health and human service benefits to which they may be entitled.
The Public Provider Reimbursement (PPR) team at HCFS works closely with state health and human agencies to enhance their ability to perform and improve their revenue cycle processes, find new revenue opportunities, and coordinate with other payers to capture revenue whenever possible. With a deep knowledge of health care reimbursement, PPR maximizes opportunities, while ensuring compliance with all applicable state and federal rules. PPR provides its clients with comprehensive medical billing and accounts receivable, as well as other services, to maximize the collection of federal, third-party, and private reimbursement for health care and related services provided by public hospitals, mental health clinics, psychiatric hospitals, skilled nursing facilities, and community-based programs. Community-based services include Home and Community-based Waivers, Residential Rehabilitation Option and Targeted Case Management programs. The program produces over $3 billion in gross charges to liable payers and generates over $1.5 million in net revenue annually.
This position will require travel and onsite work.
UMass Chan Medical School was among 23 companies that stood out as 2023 “DEI champions,” according to The Boston Globe.
“2023 BEST MEDICAL GRAD SCHOOL”
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