Job Description

Full job description

MassHealth is seeking qualified applicants for the position of Medical Coder. The Medical Coder will be responsible for providing clinical coding expertise, assuring that the ICD-10 CM/PCS (10th edition of International Classification of Diseases Clinical Modification/Procedure Coding System) code set, and other coding is implemented in a consistent, justifiable manner.

Duties and Responsibilities (these duties are a general summary and not all inclusive):

• Provide clinical coding expertise, assuring that the ICD-10 CM/PCS (10th edition of International Classification of Diseases Clinical Modification/Procedure Coding System) code set and other coding is implemented in a consistent, justifiable manner.
• Review clinical documentation and diagnostic results to extract data and apply the appropriate ICD-10 CM/PCS and CPT-4 codes for billing, internal and external reporting, research, and regulatory compliance. Codes inpatient and outpatient conditions and procedures as documented in ICD-10 CM/PCS Official Guidelines for Coding and Reporting.
• Resolve errors associated with billing and claims processing; identify and report error patterns; and design workflow changes to reduce errors.
• Coordinate and facilitate annual code updates with program staff.
• Assist in reviewing and validating MMIS ICD-10 modifications.
• Coordinate with program and operations staff, and MMIS IT to update, and maintain ICD-10 logic; and help resolve mapping discrepancies.
• Reviews provider documentation to determine principal diagnosis, co-morbidities and complications, secondary conditions and surgical procedures. Resolve questions with provider.
• Verify and abstract specific clinical and demographic data, APR-DRG assignment, and EAPG outpatient assignment.
• Assure appropriate diagnosis and grouper assignment . Extract required information from source documentation and convey to Operations and IT for data and logic updates in MMIS.
• Identify and report non-payment Provider Preventable Conditions (PPC).
• Review error reports; correct or complete missing data elements.
• Act as a resource for staff on coding issues, monitor changes in regulations that impact clinical documentations, reimbursement and coding and disseminate changes in coding rules.
• Ensure that MMIS is updated with annual code changes and updates.
• Produce clinical data and statistical reports for clinicians, researchers, financial and business planning, and clinical quality support services.
• Review training and communications materials and billing instructions and oversee staff training.

Preferred Qualifications:

• Three to five years of coding experience in a health care setting (i.e. hospital, large physician group practice, health plan, etc.).
• Proficient in ICD-9-CM ICD-10-CM/PCS and CPT coding system, DRG, APG, MS-DRG and APCs and official coding guidelines.
• Ability to plan and prepare for ICD-10CM/PCS updates.
• Knowledgeable in medical terminology, anatomy and physiology, abnormal lab results, disease processes, and pharmacology-drug names.
• Basic computer knowledge and familiarity with systems used in healthcare, proficiency with Microsoft Office.
• Excellent organizational and communication skills.
• Ability to work independently, and in a matrixed, team oriented, fast paced project environment.
• RHIA, RHIT, CCS, or CPC certification.

Required Qualifications:

• Knowledge of the methods and ability to prepare and use general reports, graphs, and tables.
• Ability to understand, explain and apply the laws, rules, regulations, policies, procedures, etc. governing assigned unit activities.
• Ability to analyze and determine the applicability of data, to draw conclusions and make appropriate recommendations.
• Ability to gather information by examining records and documents and by questioning individuals.
• Ability to assemble items of information in accordance with established procedures.
• Ability to determine proper format and procedure for assembling items of information and maintain accurate records.
• Ability to write concisely to express thoughts clearly and to develop ideas in logical sequence.
• Ability to follow written and oral instructions in a precise, understandable manner.
• Ability to establish rapport with others and maintain harmonious working relationships.
• Ability to adjust to varying or changing situations to meet emergency or changing program requirements.
• Ability to exercise sound judgment and the ability to exercise discretion in handling confidential information.

About MASSHEALTH:

To improve the health outcomes of our diverse members and their families by providing access to integrated health care services that promote sustainable & equitable health, well-being, independence and quality of life.

For more information about our agency and programs please visit:

Pre-Offer Process:

A criminal background check will be completed on the recommended candidate as required by the regulations set forth by the Executive Office of Health and Human Services prior to the candidate being hired. For more information, please visit

Education, licensure and certifications will be verified in accordance with the Human Resources Division’s Hiring Guidelines.

Education and license/certification information provided by the selected candidate(s) is subject to the Massachusetts Public Records Law and may be published on the Commonwealth’s website.

If you require assistance with the application/interview process and would like to request an ADA accommodation, please click on the link and complete the ADA Reasonable Accommodation Request Form .

For questions, please the contact the Office of Human Resources at 1-800-510-4122 and select option #4.

TO APPLY:

Please upload both Resume and Cover Letter for this position when applying.

Qualifications

First consideration will be given to those applicants that apply within the first 14 days.

MINIMUM ENTRANCE REQUIREMENTS:

Applicants must have at least (A) four years of full-time, or equivalent part-time, professional, administrative or managerial experience in business administration, business management or public administration the major duties of which involved program management, program administration, program coordination, program planning and/or program analysis, and (B) of which at least one year must have been in a supervisory capacity, or (C) any equivalent combination of the required experience and the substitutions below.

Substitutions:

I. A Bachelor's degree with a major in business administration, business management or public administration may be substituted for a maximum of two years of the required (A) experience.*

II. A Graduate degree with a major in business administration, business management or public administration may be substituted for a maximum of three years of the required (A) experience.*

III. A Bachelor's or higher degree with a major other than in business administration, business management or public administration may be substituted for a maximum of one year of the required (A) experience.*

• Education toward such a degree will be prorated on the basis of the proportion of the requirements actually completed.

NOTE: No substitutions will be permitted for the required (B) experience.

Comprehensive Benefits

When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future.

Want the specifics? Explore our Employee Benefits and Rewards!

An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.

The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don't meet 100% of the job requirements. We encourage individuals who believe they have the skills necessary to thrive to apply for this role.

Official Title : Program Coordinator III

Primary Location : United States-Massachusetts-Quincy - 100 Hancock Street

Job : Administrative Services

Agency : Exec Office Of Health and Human Services

Schedule : Full-time

Shift : Day

Job Posting : Sep 9, 2024, 9:32:43 AM

Number of Openings : 1

Salary : 73,566.74 - 107,580.72 Yearly

If you have Diversity, Affirmative Action or Equal Employment Opportunity questions or need a Reasonable Accommodation, please contact Diversity Officer / ADA Coordinator : Kendy Derival/kendy.derival3@mass.gov - 6173488456

Bargaining Unit : 06-NAGE - Professional Admin.

Confidential : No

Potentially Eligible for a Hybrid Work Schedule : Yes

Job Tags

Full time, Part time, Work experience placement, Shift work,

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