Medical Coding Specialist

2 weeks ago

Quincy, Massachusetts, United States State of Massachusetts Full time
About the Role

We are seeking a highly skilled Medical Coder to join our team at the State of Massachusetts. As a Medical Coder, you will play a critical role in ensuring the accuracy and consistency of clinical coding practices across our healthcare programs.

Key Responsibilities
  • Provide clinical coding expertise to ensure accurate and consistent coding practices
  • Review clinical documentation and diagnostic results to extract data and apply the appropriate ICD-10 CM/PCS and CPT-4 codes
  • Resolve errors associated with billing and claims processing, identify and report error patterns, and design workflow changes to reduce errors
  • Coordinate and facilitate annual code updates with program staff
  • Assist in reviewing and validating MMIS ICD-10 modifications
  • Coordinate with program and operations staff, and MMIS IT to update and maintain ICD-10 logic, and help resolve mapping discrepancies
  • Review provider documentation to determine principal diagnosis, co-morbidities and complications, secondary conditions and surgical procedures
  • Verify and abstract specific clinical and demographic data, APR-DRG assignment, and EAPG outpatient assignment
  • Assure appropriate diagnosis and grouper assignment, extract required information from source documentation and convey to Operations and IT for data and logic updates in MMIS
  • Identify and report non-payment Provider Preventable Conditions (PPC)
  • Review error reports, correct or complete missing data elements
  • Act as a resource for staff on coding issues, monitor changes in regulations that impact clinical documentations, reimbursement and coding, and disseminate changes in coding rules
  • Ensure that MMIS is updated with annual code changes and updates
  • Produce clinical data and statistical reports for clinicians, researchers, financial and business planning, and clinical quality support services
  • Review training and communications materials and billing instructions and oversee staff training
Requirements
  • Three to five years of coding experience in a healthcare setting
  • Proficient in ICD-9-CM, ICD-10-CM/PCS, and CPT coding systems, DRG, APG, MS-DRG, and APCs, and official coding guidelines
  • Ability to plan and prepare for ICD-10 CM/PCS updates
  • Knowledgeable in medical terminology, anatomy and physiology, abnormal lab results, disease processes, and pharmacology-drug names
  • Basic computer knowledge and familiarity with systems used in healthcare, proficiency with Microsoft Office
  • Excellent organizational and communication skills
  • Ability to work independently, and in a matrixed, team-oriented, fast-paced project environment
  • RHIA, RHIT, CCS, or CPC certification
About the State of Massachusetts

The State of Massachusetts is committed to improving the health outcomes of our diverse members and their families by providing access to integrated healthcare services that promote sustainable and equitable health, well-being, independence, and quality of life.

We are an equal opportunity employer and do not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law.

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