Inpatient Technical Advisor, Coding

Site: Mass General Brigham Incorporated

 

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

 

 

Job Summary

Under the general supervision of the Senior Coding Manager the Technical Advisor oversees, reviews and advised on the integrity of the ambulatory surgery coding/charging programs for the Mass General Brigham (MGB) Coding Department. The Technical Advisor advises on external/internal coding reviews and audits, new coding regulations impacts, coding and billing interlinking billing issues, coding education and workflow training for inpatient coding, claim edits and denials related to inpatient. 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. Will work very closely with multiple levels of Coding leadership, Technical Advisors, Data Quality Specialists, Coders and Clinical Documentation Improvement team to ensure an efficient and accurate coding program.

 

Qualifications

Education

• Bachelor's Degree Health Information Management required

• ICD-10-CM and CPT education required for both the Hospital and Professional coding.

Experience

• 3-5 years of experience required in clinical coding within a healthcare setting, with a focus on coding accuracy and compliance.

Knowledge, Skills and Abilities

• In-depth knowledge of coding systems, such as ICD-10-CM, CPT, and HCPCS, as well as familiarity with coding guidelines and regulations (e.g., HIPAA, HITECH Act).

• Strong analytical and problem-solving skills, with the ability to review complex medical records and identify coding errors or inconsistencies.

• Excellent communication and interpersonal skills, with the ability to collaborate effectively with multidisciplinary teams and healthcare professionals.

• Proficiency in using coding software and electronic health record (EHR) systems.

• Detail-oriented mindset and ability to work in a fast-paced environment, meeting deadlines and managing multiple priorities.

• Up-to-date knowledge of industry trends, emerging technologies, and regulatory changes related to clinical coding.
   

Principal Duties and Responsibilities

• Provides data and support to the overall coding compliance and audit program. Provides data needed to update staff, Senior Leadership and entity partners regarding audit findings and action plans as well as coding related regulatory changes and impacts.

• Assists in the development and revision of program policies and procedures and internal guidance documents.

• Recommends updates to the Coding Compliance manual.

• Works closely with coding management and Data Quality Specialists in developing criteria and evaluating the quality of coding provided by the program. 

• Provides program related SME liaison as needed with entity CDI and quality teams. Serves on entity and enterprise committees as required.

• Ensures that all audit, compliance and educational activities are appropriately documented.

• Assists as SME in all aspects of internal and external coding audit activities providing root cause analysis and recommendations based on trends in findings.

• Assists with development, implementation and management of program education materials and notifications to staff.

• Recommends and/or provides coder education as required based on audit findings.

• Participates and/or facilitates staff meetings as required.

• Assists CDI teams in providing specialty-based documentation improvement education as required.

• Works closely with corporate and entity Audit and Compliance teams as required.

• Keeps abreast of all developments in the coding, audit and compliance field and continues to improve leadership and management skills through participation in professional activities, continuing education and other related activates.

• Supports Claim edits, denials and customer service inquiries as peer reviewer. 

• SME to internal departments (Vendor Management) – such as responding to vendor questions, WQ surveillance.