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Exemption Status:
Exempt
Schedule Details:
Monday through Friday
Scheduled Hours:
7:30 am - 4:00 pm
Shift:
1 - Day Shift, 8 Hours (United States of America)
Hours:
40
Cost Center:
99940 - 5458 Coding Services
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.
Plans and supervises the daily operations associated with the HIM Coding Validation team. Coordinates work of validators and monitors both progress and work quality. Trains employees, provides employee performance data, and fosters process improvements Performs focused account and quality reviews of coded records to support the ongoing performance management process. Validates the Diagnosis Related Group (DRG) and current editions of ICD-CM, ICD-PCS, and CPT code assignment to ensure consistency and efficiency in the processing, data collection, and quality reporting associated with inpatient and outpatient claims.
Major Responsibilities:
1. Distributes and monitors the daily activities associated with the flow of work for inpatient coding and / or outside vendors.
2. Provides training and technical assistance to employees within the assigned work area.
3. Provides effective direction, guidance, and leadership over the staff for effective teamwork and motivation and fosters the effective integration of efforts with system-wide initiatives.
4. Directs and supervises assigned personnel including performance evaluations, scheduling, orientation, and training.
5. Hires employees, transfers, promotions, salary changes, discipline, terminations, and similar actions.
6. Resolves grievances and other personnel problems within position responsibilities.
7. Relays work instruction from the Manager of Coding Education and Quality.
8. Assists the Manager of Coding Education and Quality in assuring that assigned employees are provided with appropriate resources, materials, and methods.
9. Acts as a point person / department resource for special projects / programs and responds to coding related questions and issues.
10. Provides instruction and feedback to the Manager of Coding Education and Quality regarding proper coding assignment as necessary.
11. Runs daily reports to ensure all outstanding encounters are coded.
12. Informs the Manager of Coding Education and Quality when backlog situations arise.
13. Assists in resolving incomplete and / or missing chart documentation in order to expedite coding and billing.
14. Assists the Manager of Coding Education and Quality in performance improvement initiatives and demonstrates the use of quality improvement in daily operations.
15. Assists the Manager of Coding Education and Quality in meeting department / unit goals and ensuring compliance with regulatory agencies such as Joint Commission, DPH, etc.
16. Works closely with Clinical Documentation Improvement (CDI) Program team to continuously monitor the quality of clinical documentation to identify incomplete or inconsistent documentation in addition to any changes in DRG assignment and payment.
17. Monitors retrospective queries for appropriateness and may provide Validators feedback. Informs the Manager of Coding Education and Quality of any identified concerns.
18. Collaborates with the Manager of Coding Education and Quality as the primary department resource for the dissemination of DRG interpretations.
19. Collaborates with the Manager of Coding Education and Quality to provide ongoing education to the Validation staff, Providers, and other clinicians to ensure appropriate assignment of current edition of ICD-CM, DRGs, E/M codes as well as modifiers and CPT procedure changes.
20. Assists the Manager of Coding Education and Quality in preparing productivity reports and participates in the department's total quality management studies.
21. 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.
22. Attends required training classes and coding in-services each year to stay abreast of new regulations and coding guidelines.
23. Monitors Medicare and other DRG payer bulletins and manuals. Reviews current Office of Inspector General (OIG) work plans for DRG risk areas.
24. Keeps current with all coding updates and information related to correct coding.
Standard Staffing Level Responsibilities :
1. Complies with established departmental policies, procedures and objectives.
2. Attends variety of meetings, conferences, seminars as required or directed.
3. Demonstrates use of Quality Improvement in daily operations.
4. Complies with all health and safety regulations and requirements.
5. 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.
6. Maintains, regular, reliable, and predictable attendance.
7. Performs other similar and related duties as required or directed.
All responsibilities are essential job functions.
Position Qualifications:
License/Certification/Education:
Required:
1. Bachelor's degree in Business or Health Care Administration.
2. Certification as a Certified Coding Specialist (CCS).
Preferred:
1. Certification as a Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT).
Experience/Skills:
Required:
1. Minimum of five (5) years of experience coding in a large, teaching, acute tertiary care setting with demonstrated coding expertise.
2. Extensive knowledge of current editions of DRGs, ICD-CM, ICD-PCS, and/or CPT coding systems.
3. Through knowledge of third-party payer requirements as well as federal and state guidelines and regulations pertaining to coding and billing practices.
4. General knowledge of hospital information systems as well as extensive knowledge of computer systems / applications used in HIM.
5. General knowledge of the retrospective CDI query process as well as guidelines for achieving a compliant query and associated compliance concerns.
6. Excellent customer service skills with the ability to communicate efficiently.
7. Exceptional organizational skills with attention to detail.
8. Ability to lead, organize, and support the work of less senior Validators is a primary function of this position.
9. Ability to work independently within established guidelines.
10. Excellent oral and written communication skills required.
11. Ability to motivate, train and teach individuals, demonstrating skills in interpersonal relationships and in oral and written communication.
12. Ability to organize and coordinate multiple functions and tasks.
13. Ability to problem solve, organize, and prioritize workload to meet productivity benchmarks.
14. Ability to withstand significant level of on-going pressure, and ability to deal with individuals with tact, discretion, and diplomacy.
Preferred:
1. Coding review experience in DRG assignment, and current editions of ICD-CM, ICD-PCS and CPT coding with previous claims processing and data management responsibility.
2. Prior supervisory 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 We will make every effort to respond to your request for disability assistance as soon as possible.

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