Remote Coding Quality Assurance Specialist, Per Diem-(3307914) - Partners Healthcare System

General Summary/ Overview

Reporting directly to and under the general direction of the Manager, Revenue Cycle Quality Assurance, the Quality Assurance Specialist (QAS) responsible for auditing services performed throughout -Revenue Cycle Operations functions.

The Coding Quality Assurance Specialist performs quality review assessments on all MGB RCO codes assigned to classify diagnoses, services, surgeries, procedures, visits, encounters, and hospital discharges to determine accuracy. The codes may be assigned by coders both employed or contracted, physicians, other qualified providers, or automation. The Coding Quality Assurance Specialist takes part in all coding reviews as scheduled by the Coding Education Team or as requested by other staff members and stakeholders. is responsible for evaluating medical records to determine the accuracy of coding, billing and documentation related to hospital/facility and/or professional services and upholding compliance standards. The Coding Quality Assurance Specialist works collaboratively with the Coding Education Team to ensure that all reviews are accurate, and that the scoring and reporting of review results are done timely and accurately in accordance with approved reporting methods developed by the Coding Education Team and Coding Management. The Coding Quality Assurance Specialist also works with the Coding Education Team to assist in preparation and presentation of education materials as needed and/or requested by the Coding Education Manager. The Coding Quality Assurance Specialist is also responsible for identifying trends and areas for coding improvement and for ensuring that appropriate feedback is given to coders based on quality assurance review findings.

Principal Duties and Responsibilities:

• Perform coding audits and related duties of moderate to high complexity work using established Coding Services policies and procedures in an accurate and timely manner. Review, conduct, and document quality assurance assessments and results via a scheduled quality assurance plan or on request.

• Perform baseline and ongoing quality assessments of coder work quality including, but not limited to, proper coding convention and guidelines, MGB RCO policies, and governmental and/or payer guidelines as appropriate.

• Demonstrate a commitment to integrating coding compliance standards into daily coding audit practices. Identify, correct, and report coding deficiencies.

• Maintain current knowledge of coding, compliance, and reimbursement procedures. Review current literature, newsletters, payor policy updates and coding manuals. Identify trends and areas for improvement and work collaboratively with the Coding Education Team to help provide education and training on these areas.

• Ensure optimal reimbursement of all cases in compliance with governmental policies and procedures and the Official Coding Guidelines

• Regularly and accurately report findings to The Coding Education Team Manager via the approved scoring, tracking, and reporting mechanisms.

• Adheres to HIPAA security standards and handles confidential information with tact and poise.

• Provide limited cross-coverage in areas of coding audit performed.

• Perform peer to peer quality assurance reviews in equal or lower complexity areas of expertise.

• Complete special projects as assigned by manager.

• Assist Coding Education Team to prepare and present education materials based on findings in QA reviews as well as trends and research from recognized industry standard coding sources and/or payer policies.

• Perform coding related research using officially recognized coding sources and payer policies.

• Other duties and responsibilities as assigned

Education

• Associate or Bachelor’s degree preferred or the equivalent combination of training and experience.

• Coding Certification from American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) is required. Accepted credentials include certifications CPC®, CPC-H, CCS, CCS-P or RHIA or RHIT credentials and appropriate experience.

Work Experience

• 2+ years of direct auditing experience in relevant service line. Managed Care environment.

• 5+ of coding experience in Managed Care, medical billing, facility, or physician environment required.

• Thorough knowledge of ICD-10, CPT, HCPS, and Revenue Billing Codes.

• Ability to write clearly and succinctly in a variety of communication settings and styles.

• Excellent communication and presentation skills across various levels and through multiple channels (oral, written, conversational).

• Strong quantitative and analytical skills.

• Ability to apply expertise in various training formats.

• Experience in Epic is preferred.

Skills/Abilities/Competencies:

• Advanced Proficiency in ICD-10-CM, CPT®, HCPCS, and modifiers for coding of professional fee services.

• Advanced knowledge of anatomy and physiology, medical terminology and insurance reimbursement policies and regulations.

• Excellent written and verbal communication skills and the ability to prioritize and organize work to meet strict deadlines are required.

• Able to code medium/moderately complex work. (May occasionally code high or low complexity work as deem capable and requested by manager)

• Understands, retains, and can research coding billing rules, regulations, and requirements.

• Able to critically think through processes in coding to recognize errors and/or problems. Understands reasons for actions on edits.

• Able to share/transfer knowledge or train co-workers, peers, billing managers on coding

• Able to provide education with physicians in small group or one-on-one sessions as needed or requested.

• Able to provide feedback to billing managers, physicians, staff, and others independently with occasional guidance from manager.

• Able to provide cross-coverage of multiple specialties.

• Able to perform peer to peer quality assurance reviews in equal or lower complexity areas of expertise.

• Accuracy and attention to detail

• Proficient with computer applications (MS Office etc), Excellent data entry skills

Supervisory Responsibilities:

• Direct Reports | None

Fiscal Responsibility:

• No direct budgetary responsibility

• Demonstrates fiscal responsibility by effectively using Mass General Brigham resources

Working Conditions:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

• This position is Remote but with the expectation that folks may be asked to come into the office, on average, once per quarter for up to 4 business days (travel will be reimbursed per MGB policy).

• Hospital work environment working conditions include possible exposure to diseases or infections and may require safety gear (PPE) such as gloves and mask.

• Normal office working conditions. The noise level in the work environment is quiet to moderate.

• While performing the duties of this job, the employee is frequently required to sit; talk; or hear; use hands to finger; handle; or feel; reach with hands and arms. The employee is occasionally required to stand; walk; and stoop; kneel; or crouch. The employee must frequently lift and/or move up to 5 pounds and occasionally lift and/or move up to 20 pounds.

• Specific vision abilities required by this job include close vision, distance vision and depth perception.

Mass General Brigham 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 the law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, perform essential job functions, and receive other benefits and privileges of employment.