Medical Record Coder

New England Baptist Hospital Boston , MA 02298

Posted 2 months ago


Under the direction of the Professional Revenue Integrity Manager

Essential Tasks / Responsibilities

  • Conducting focused compliance assessments of CPT/HCPCS and ICD code assignment

  • Evaluating billed charge data and professional services claims (e.g. CMS-1500) for accuracy of claim reporting requirements

  • Evaluating the adequacy of medical record documentation for professional services providers

  • Preparing reports / audit results as required related to the specific auditing activities performed

  • Analyzing coded data to assess billing patterns and identify potential aberrant billing patterns

  • Analyzing claim denials and associated claim documentation to determine cause and potential resolution

  • Providing recommendations to providers and management

  • Developing and implementing processes that will effectively monitor/track compliance requirements, reporting, and performance metrics / scorecards etc.

  • Interfacing with NEBH revenue cycle and third-party billing vendors, if applicable, to facilitate analysis and/or issue resolutions, as applicable

  • Developing, conducting, and/or coordinating provider coding / documentation training including implementation and maintenance of provider training resources / references

  • Conducting NEBMA, SPINE CTR & NEBMA Hospitalist group coding review and updating requests daily

  • Fulfilling all medical note review requests (OPTUM, BCBS, etc.)

  • Providing educational materials and coding accuracy to clinicians

  • Analyzing billing company reports

Qualifications / Skills

  • Strong reading comprehension skills

  • Solid oral and written communication skills

  • Native or Fluent proficiency in English language

  • Excellent typing and 10-key speed and accuracy

  • Strong knowledge of anatomy, physiology, and medical terminology

  • Attention to detail, organization, and time management skills

  • Microsoft Office skills (Outlook, Word, Excel, PowerPoint)

  • Ability to work on numerous software applications systems and a willingness to learn

  • Ability to work both independently and as a team player within a hybrid environment

Education, Experience, and Licensing Requirements

  • High school diploma, GED, or equivalent required, university/college degree is a plus

  • 1 year of medical coding experience required, 2+ years preferred

  • CCS, CCS-P, CCA, CPC, COC, or CPC-A required

  • Experience working in medical office and communicating with clinicians preferred

  • Experience with medical billing and CMS-1500 forms preferred

  • Experience using eClinicalWorks, Soarian, Medaptus, or Optum EncoderPro is a plus

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Medical Record Coder

New England Baptist Hospital