New

Remote Per Diem Coder, Ortho

Mass General Brigham (Enterprise Services)
United States, Massachusetts, Somerville
399 Revolution Drive (Show on map)
May 24, 2025
Summary: Responsible for reviewing patient medical records after a visit and translating the information into codes that insurers use to process claims from patients. Duties include confirming treatments with medical staff, identifying missing information and submitting information to insurers for reimbursement. Participates in peer review to ensure accuracy and timeliness standards are maintained. Resolve complex coding questions that arise from team. Does this position require Patient Care? No Essential Functions: Evaluates medical record documentation and coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflect and support outpatient visits and to ensure that data complies with legal standards and guidelines. -Interprets medical information such as diseases or symptoms and diagnostic descriptions and procedures to accurately assign and sequence the correct ICD-10 and CPT codes. -Provides technical guidance to physicians and other staff in identifying and resolving issues or errors such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, and/or codes that do not conform to approved coding principles/guidelines. -Manages complex coding situations and supports peers through challenging questions. -Peer reviews records for management to ensure accuracy of information. -Audits clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes. -Researches, analyzes, recommends, and facilitates plan of action to correct discrepancies and prevent future coding errors. -Identifies reportable elements, complications, and other procedures. *KILLS/ ABILITIES/ COMPETENCIES REQUIRED:* Advanced Proficiency in ICD-10, CPT, HCPCS, and modifiers for coding of professional fee services. Advanced knowledge of anatomy and physiology, medical terminology and insurance reimbursement policies and regulations. Excellent written and verbal communication skills and the ability to prioritize and organize work to meet strict deadlines are required. Able to code high complexity work. (May occasionally code medium or low.) Able to critically think through processes in coding to recognize errors and/or problems. Understands reasons for actions on edits. Able to share/transfer knowledge or train co-workers, peers, billing managers on coding - Able to provide education with physicians in various group sessions as needed or requested. Able to provide education with physicians in various size group sessions as needed or requested. Able to provide feedback to billing managers, physicians, staff, and others independently without guidance from manager. Able to provide cross-coverage of multiple complex specialties. Able to perform peer to peer quality assurance reviews in equal or lower complexity areas of expertise. Accuracy and attention to detail Proficient with computer applications (MS Office etc), Excellent data entry and computer skills required. *QUALIFICATIONS:* High school diploma required Course work in anatomy and physiology, medical terminology strongly preferred. Coding Certification from American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) is required.Certification may include CPC, COC, CCS, CCS-P. Additional coding certifications preferred (Specialty and/or related) but not required. Completion of a Coding Certificate program or Health Information Technology Program or >2 years work experience equivalent required. A Minimum of 5 years of experience in coding required. 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.