Coder

Are you a current UMass Memorial Health caregiver? Apply now through Workday.

Exemption Status

Non-Exempt

Schedule Details

Monday through Friday

Scheduled Hours

0800-430

Shift

1 - Day Shift, 8 Hours (United States of America)

Hours

40

Cost Center

99940 - 5458 Coding Services

Union

SHARE (State Healthcare and Research Employees)

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

Interprets a wide variety of clinical and diagnostic documentation, including complex medical cases and treatments, to identify: diagnoses, complications, comorbidities, and procedures associated with episodes of inpatient care. Assigns appropriate Diagnosis Related Group (DRG) to each coded inpatient account to obtain optimal hospital reimbursement, Severity of Illness (SOI), and Risk of Mortality (ROM). Assigns current edition of ICD-CM, ICD-PCS, and CPT codes as appropriate adhering to official coding guidelines.

I. Major Responsibilities

• Upon review of the medical record, performs analysis on documentation, which includes: History & Physical (H&P), progress notes, flow sheets, Provider orders, consultations, operative reports, pathology results, and additional tests / reports to determine the appropriate current edition ICD-CM diagnosis and ICD-PCS codes as defined by official coding guidelines, the Coding Clinic, and other recognized reference materials.
• Reviews clinical documentation to ensure accurate discharge disposition is assigned and notifies Manager when clarification is needed.
• Assigns the correct principal diagnosis, comorbidities and complications (CCs), secondary diagnoses, POA (Present on Admission) indicators, HAC (Hospital-Acquired Conditions), principal procedure codes, and secondary procedure codes according to official coding guidelines, the Coding Clinic, and in accordance with all official Uniform Hospital Discharge Data Set (UHDDS) definitions.
• Based upon the assigned codes, utilizes the computerized 3M Encoder software to assign the most accurate DRG.
• Initiates the retrospective query process when documentation is inconsistent, incomplete, ambiguous, or non-specific.
• Works closely with the Clinical Documentation Improvement (CDI) Program, Retrospective CDIS Nurse, or Manager to improve medical record documentation.
• Assists in resolving incomplete and / or missing chart documentation in order to expedite coding and billing.
• Participates in the continuous coding audit and performance management program.
• Maintains DRG and coding accuracy rate of not less than 95% for optimal reimbursement as well as department productivity standards as outlined in department policies.
• Attends required training classes and coding in-services each year to stay abreast of new regulations and coding guidelines.
• Participates in improvement efforts and documentation training for medical and clinical staff as it relates to coding practices and guidelines.
• Communicates to direct Manager when backlog situations arise or necessary documents are either incorrect or are not being received in a timely manner.
• Refers all unusual, questionable situations to the Inpatient Coder Lead or Supervisor of Inpatient Coding. Alerts management to any coding irregularities, or trends contrary to policies and procedures, so corrective measures may be taken.
• Adheres to the coding and billing regulations established by the American Hospital Association (AHA), American Medical Association (AMA), and Centers for Medicare and Medicaid Services (CMS).
• Maintains direct and ongoing communications with other coding personnel to maximize overall effectiveness and efficiency of the operation.
• Keeps current with all coding updates and information related to correct coding.
  
  

Standard Staffing Level Responsibilities

• Complies with established departmental policies, procedures and objectives.
• Attends variety of meetings, conferences, seminars as required or directed.
• Demonstrates use of Quality Improvement in daily operations.
• Complies with all health and safety regulations and requirements.
• Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.
• Maintains, regular, reliable, and predictable attendance.
• Performs other similar and related duties as required or directed.
  
  

II. Position Qualifications

All responsibilities are essential job functions.

License/Certification/Education

Required:

• Level of knowledge equivalent to an Associate or bachelor’s degree in Health Information Management.
• Certification(s) as a Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Specialist – Physician (CCS-P), or Certified Coding Associate (CCA) required upon hire or within one year of hire or equivalent experience.
  
  

Experience/Skills

Required:

• Proficient in utilizing multiple payer-specific DRG groupers as required by individual payers.
• Thorough knowledge of the current editions of DRG, ICD-CM, ICD-PCS, and CPT coding systems.
• Thorough knowledge of third-party payer requirements as well as federal and state guidelines and regulations pertaining to coding and billing practices.
• Excellent customer service skills with the ability to communicate efficiently.
• Exceptional organizational skills with attention to detail.
• Ability to work independently within established guidelines.
• Excellent oral and written communication skills.
• Ability to organize and coordinate multiple functions and tasks.
• Ability to problem solve, organize and prioritize workload to meet productivity benchmarks.
• Ability to withstand significant level of on-going pressure, and ability to deal with individuals with tact, discretion and diplomacy.
  
  

Preferred

• Two (2) years of inpatient coding experience.
  
  

Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.

Department-specific competencies and their measurements will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with position incumbents.

III. Physical Demands And Environmental Conditions

Work is considered sedentary. Position requires work indoors in a normal office environment.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We’re striving to make respect a part of everything we do at UMass Memorial Health – for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at [email protected]. We will make every effort to respond to your request for disability assistance as soon as possible.