Coding Quality Specialist

Summary

Responsible for monitoring, assessing, and improving the quality of coding processes, documentation, and adherence to coding guidelines and regulations by enhancing coding accuracy, minimizing errors, and promoting coding compliance.

Does this position require Patient Care? No

Essential Functions

• Develop and implement coding quality assurance programs to evaluate the accuracy, completeness, and compliance of medical coding practices.
• Ensure coding practices align with official coding conventions, guidelines, and regulatory requirements set forth by organizations such as the American Medical Association (AMA), Centers for Medicare and Medicaid Services (CMS), and other relevant bodies.
• Analyze medical records, physician notes, and other relevant documentation to assess the adequacy and specificity of documentation supporting the assigned codes.
• Develop and deliver coding education and training programs to coders, physicians, and other healthcare professionals to enhance coding knowledge, documentation practices, and coding accuracy.
• Identify opportunities to streamline coding workflows, enhance efficiency, and improve coding accuracy.
• Establish key quality metrics and reporting mechanisms to monitor and track coding accuracy, productivity, and compliance.
• Foster effective communication and collaboration with healthcare providers, coders, billing staff, and other stakeholders to address coding-related inquiries, clarify documentation requirements, and resolve coding issues.

Education

Associate's Degree Medical Billing and Coding required

Experience

5-7 years of Medical Coding experience required

1-2 years of Quality Assurance experience preferred

Knowledge, Skills and Abilities

Advanced knowledge of medical coding systems, including ICD-10, CPT, and HCPCS, and their application in hospital billing.

Knowledgeable of coding guidelines and regulations, including those set by the AMA, CMS, and other relevant organizations.

Strong analytical skills and attention to detail to accurately interpret medical documentation and assign appropriate codes.

Excellent understanding of anatomy, physiology, medical terminology, and disease processes to support accurate coding.

Excellent communication skills, both written and verbal, to interact effectively with healthcare providers and billing staff.

Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.

Physical Requirements

Mass General Brigham Incorporated is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and / or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.