Specialist

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Exemption Status

Non-Exempt

Hiring Range

$21.69 - $35.90

Please note that the final offer may vary within this range based on a candidate’s experience, skills, qualifications, and internal equity considerations .

Schedule Details

Monday through Friday

Scheduled Hours

7-3:30

Shift

1 - Day Shift, 10 Hours (United States of America)

Hours

40

Cost Center

99940 - 5452 RI and Charge Capture

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.

Position Summary

Interprets clinical and diagnostic documentation in order to process or pro-fee charges for episodes of outpatient /inpatient care. Assigns appropriate ICD-CM (current edition) and / or CPT codes as well as modifiers, as appropriate adhering to official coding guidelines.

Major Responsibilities

Upon review of the medical record, performs analysis on documentation, which includes review of tests / reports to determine the appropriate ICD-CM (current edition) and / or CPT codes as well as modifiers as defined by official coding guidelines and other recognized reference materials, i,e, Optum Encoder, CCI edits, leveling, etc. Verifies documentation is present to substantiate codes assigned. 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 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 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 direct Supervisor/Manager. Alerts management to any coding irregularities, or trends contrary to policies / procedures, so corrective measures may be taken. Adheres to the coding and billing regulations established by the 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, and contributes in 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.

Position Qualifications

All responsibilities are essential job functions.

License/Certification/Education

Required:

High School diploma or equivalent Successful completion of a Medical Billing and Coding Program. Coding Certification in Professional Coding or must be obtained within 6 months of acceptance as a condition of employment. Medical terminology.

Experience/Skills

Required:

Knowledge of ICD-CM (current edition) and CPT coding systems as well as CCI edits. Knowledge of third-party payer requirements as well as federal and state guidelines and regulations pertaining to coding and billing practices. Good interpersonal and communications skills and demonstrates professionalism Good customer service skills with the ability to communicate efficiently. Good organizational skills with attention to detail. Ability to work independently within established guidelines. Ability to problem solve, organize and prioritize workload to meet productivity benchmarks.

Preferred

One (1) year of medical abstraction and outpatient coding experience or related work experience.

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.