Coding Technical Advisor at Partner's Healthcare in Somerville, Massachusetts

Job Description:

Site: Mass General Brigham Incorporated


At Mass General Brigham, we know it takes a surprising range of talented professionals to advance our mission-from doctors, nurses, business people and tech experts, to dedicated researchers and systems analysts. As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve.


At Mass General Brigham, we believe a diverse set of backgrounds and lived experiences makes us stronger by challenging our assumptions with new perspectives that can drive revolutionary discoveries in medical innovations in research and patient care. Therefore, we invite and welcome applicants from traditionally underrepresented groups in healthcare - people of color, people with disabilities, LGBTQ community, and/or gender expansive, first and second-generation immigrants, veterans, and people from different socioeconomic backgrounds - to apply.



Job Summary
About Us:
As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women's Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.


We're focused on a people-first culture for our system's patients and our professional family. That's why we provide our employees with more ways to achieve their potential. Mass General Brigham is committed to aligning our employees' personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development-and we recognize success at every step.


Our employees use the Mass General Brigham values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.



Qualifications



Position Overview:


Under the general supervision of the Coding Manager - Claim Edits and Denials, the Technical Advisor oversees, reviews, and advises on the data integrity of the claim edit and denials coding programs for the Mass General Brigham (MGB) Coding Department. The Technical Advisor advises on external/internal coding reviews and audits, new coding/billing regulations impacts, coding and billing interlinking billing issues, coding education and workflow training for outpatient coding, claim edits and denials. Technical Advisor assists on the MGB Coding and Revenue Cycle-wide projects as needed. Technical Advisor assists on writing policies and procedures; coding system implementation projects; and coding education in their area of expertise. The Technical Advisor will work very closely with multiple levels of Coding leadership, Technical Advisors, Data Quality Specialists and Coding Specialists to ensure an efficient and accurate coding program.



Principal Duties and Responsibilities

• Advises on a system-wide claim edits and denials coding program to ensure workflow adherence and coding compliance. Informs and advises on regulation change impacts, coding changes, and system issues. Utilizes resources including, but not limited to the Coding Clinics published by the American Hospital Association (AHA), CPT Assistant, Office of Inspector General regulations (OIG), CMS regulatory changes, and payer groups.


• Advises and assists on coding related issues for external groups, e.g. public and third-party payors. Including review of cases to advise if it is a coding, clinical documentation, or other issue(s) to be addressed by other departments.


• Reviews assigned documents to be updated as needed. This may include MGB Coding policies and procedures, MGB Coding tip sheets, MGB Coding Edit/Denials Processing Tools, MGB Coding Compliance Plan, workflow documentation, claim edit resolution guidance among other documents.


• Oversees and monitors work queue volumes to ensure appropriate coverage and optimization of Coding department productivity KPIs.


• Performs claim edits and denials coding analyses by work-type as needed, determines if there are any trends, and prepares reports for reviews utilizing data in quality data reports to support remediation efforts.


• Facilitates and works closely with Revenue Cycle Operations (RCO) departments such as Revenue Integrity (RI), the Patient Financial Services (PFS), and local Revenue Operations (RO) teams to identify and resolve claims editing issues, denials, and rejections to optimize workflows throughout the revenue cycle.


• Subject Matter Expert (SME) to external local and enterprise departments such as Case Management, Revenue Integrity, Revenue Operations and Patient Financial Services for CPT and ICD-10 appropriateness and accuracy when determining such things as medical necessity.


• Closely monitors days to timely file limit (TFL) and days on work queue (delinquency): proactively escalates TFL claims to appropriate vendor coding team, responsible for the timely completion of TFL and delinquent claims and responding to RCO Weekly TFL and Delinquent Reports.


• Communicates with entity departments on open encounters, missing documentation and missing/pending charges weekly.


• Attends weekly Claim Edit Processing and Claim Reconciliation Database meetings to participate in claim edit resolutions.


• Supports claim edits, denials, and customer service inquiries as Technical Advisor.


• Subject Matter Expert (SME) to internal departments (Vendor Management) - such as responding to vendor questions, WQ surveillance.


• Formulates recommendations for education and gives in-service presentation to the Coding Specialists as needed.


• Monitors and filters information that provides updates on regulatory changes that may impact coding.


• Researches information for departmental and interdepartmental staff on coding topics or other clinical information needed in a timely manner.


• May be asked to code in production coding work queues relevant to the Technical Advisor role and/or skill set as needed.


• May be assigned to train and audit Coding Specialists in various work-types.


• Supports and assists the Coding leadership with all assignments as requested.

Qualifications:



Education and Experience Required

• AS or BS in Health Information Technology/Administration or related health care administration required.


• ICD-10-CM and CPT-4/HCPCS education required.


• 3+ years of broad ranged coding experience including extensive ICD-10-CM, CPT-4/HCPCS, outpatient coding guidelines and payor policies is required.


• Strong outpatient coding claim edit, and denial experience is required.


• Experience at an academic medical center is preferred.


• Data and Analytics experience is preferred.


• Supervisor/Auditor/Trainer experience is preferred.

Certification/Credentials Required

• AHIMA RHIT or RHIA credentials are strongly preferred.


• Coding credentials from AAPC or AHIMA is required and may include CCS, CCS-P CCA, CPC, COC.


• AHIMA and/or AAPC credential maintenance is required through Continuing Education Units (CEU).

Skills/Abilities/Competencies Required

• Extensive experience with computer systems including Coding and clinical data/billing systems.


• EPIC and 3M experience (preferred).


• Extensive Microsoft office experience, especially Word, Excel, PowerPoint.


• Excellent communication and interpersonal skills for remote teamwork.


• Ability to complete projects within presented timelines and deadlines.


• Ability to manage multiple projects and tasks.


• Strong analytical skills.


• Ability to work independently yet remain a team player.

Working Conditions

• Extensive use of computer equipment and software including Outlook and Teams.


• Frequent interaction with staff across all levels of the organization.


• Low physical effort


• Occasional bending, stooping, kneeling, crouching and/or reaching.


• Travel to Assembly Row may be required.

EEO Statement



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.



Additional Job Details (if applicable)



Remote Type


Remote



Work Location


399 Revolution Drive



Scheduled Weekly Hours


40



Employee Type


Regular



Work Shift


Day (United States of America)



EEO Statement:


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.




Mass General Brigham Competency Framework



At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline. Apply Now