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GENERAL SUMMARY OF POSITION: 

Under the general supervision of the Assistant Director or designee, the Medical Coding Supervisor is responsible for performing and supervising inpatient and outpatient medical coding work and staff to be used for federal claiming purposes.

MAJOR RESPONSIBILITIES:

• Manages and assigns medical coding workload for high volume inpatient, outpatient and ancillary services including medical, behavioral health, intensive care, surgical and other specialty services.
• Supervises the day-to-day activities of the medical coding staff.
• Monitors the accuracy and as needed assists with the assignment of the appropriate ICD-9 (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 assists with the assignment of the appropriate CPT-4 (or its successor), ICD diagnosis and procedure codes for inpatient, outpatient or ancillary services. 
• Reviews the research, analysis, and re-coding of national medical necessity (NCD) denials and local medical review (LMRP) denials for Medicare patients performed by staff
• Conducts concurrent CPT code review of inpatient initial E&M services and shared visits
• Monitors and supervises the completion of concurrent CPT coding reviews for various outpatient clinics
• Schedules and provides front end training and education to clinical staff for issues identified in concurrent CPT coding reviews.
• Reviews the CPT code assignment for “Other” procedures on the Outpatient Encounter Forms
• Resolves problems and answers questions from staff promptly.
• Maintains and distributes the most current coding information and implement changes.
• 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, including ICD-10 training and implementation
• Ensures that staff attend ICD-10 training and monitor accuracy of work during the transition
• 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

REQUIRED QUALIFICATIONS:

• Bachelors Degree in medical terminology or related field; or equivalent
• 3-4 years of medical coding experience to include at 1 year of supervisory experience
• Certified Professional Coder (CPC)
• Comprehensive knowledge of regulatory requirements, including HIPAA
• Knowledge of current healthcare and medical terminology, including ICD-9 and CPT-4 codes
• High degree of organization and strong attention to detail
• Ability to communicate, problem solve and assign work effectively
• Experience with multiple specialty coding including Cardiology, GI, Oncology, and Orthopedics
• Proficient in computer skills and Microsoft Office
• Must maintain CPC certification

PREFERRED QUALIFICATIONS:

• Knowledge of state and federal rules and regulations related to health care finance
• Ability to plan, prioritize and schedule multiple work tasks
• Experience with MEDITECH Health Information System
• ICD-10 Certification

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 supervise Medical Coding services provided to our providers operated by the Departments of Mental and Public Health.  Specifically this position will support the expansion of coding services to 5 additional inpatient sites including Cape Cod and Islands (inpatient only), Corrigan (inpatient only), Fuller, Taunton and Worcester and the Substance Use Treatment Program.