Coding Technical Advisor

DescriptionPosition Overview:Under the general supervision of the Coding Manager – Claim Edits and Denials, the Technical Advisor oversees, reviews, and advises on the data integrity of the claim edit and denials coding programs for the Mass General Brigham (MGB) Coding Department. The Technical Advisor advises on external/internal coding reviews and audits, new coding/billing regulations impacts, coding and billing interlinking billing issues, coding education and workflow training for outpatient coding, claim edits and denials. 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. The Technical Advisor will work very closely with multiple levels of Coding leadership, Technical Advisors, Data Quality Specialists and Coding Specialists to ensure an efficient and accurate coding program.Principal Duties and ResponsibilitiesAdvises on a system-wide claim edits and denials coding program to ensure workflow adherence and coding compliance. Informs and advises on regulation change impacts, coding changes, and system issues. Utilizes resources including, but not limited to the Coding Clinics published by the American Hospital Association (AHA), CPT Assistant, Office of Inspector General regulations (OIG), CMS regulatory changes, and payer groups. Advises and assists on coding related issues for external groups, e.g. public and third-party payors. Including review of cases to advise if it is a coding, clinical documentation, or other issue(s) to be addressed by other departments.Reviews assigned documents to be updated as needed. This may include MGB Coding policies and procedures, MGB Coding tip sheets, MGB Coding Edit/Denials Processing Tools, MGB Coding Compliance Plan, workflow documentation, claim edit resolution guidance among other documents. Oversees and monitors work queue volumes to ensure appropriate coverage and optimization of Coding department productivity KPIs.Performs claim edits and denials coding analyses by work-type as needed, determines if there are any trends, and prepares reports for reviews utilizing data in quality data reports to support remediation efforts.Facilitates and works closely with Revenue Cycle Operations (RCO) departments such as Revenue Integrity (RI), the Patient Financial Services (PFS), and local Revenue Operations (RO) teams to identify and resolve claims editing issues, denials, and rejections to optimize workflows throughout the revenue cycle.Subject Matter Expert (SME) to external local and enterprise departments such as Case Management, Revenue Integrity, Revenue Operations and Patient Financial Services for CPT and ICD-10 appropriateness and accuracy when determining such things as medical necessity. Closely monitors days to timely file limit (TFL) and days on work queue (delinquency): proactively escalates TFL claims to appropriate vendor coding team, responsible for the timely completion of TFL and delinquent claims and responding to RCO Weekly TFL and Delinquent Reports.Communicates with entity departments on open encounters, missing documentation and missing/pending charges weekly.Attends weekly Claim Edit Processing and Claim Reconciliation Database meetings to participate in claim edit resolutions.Supports claim edits, denials, and customer service inquiries as Technical Advisor.Subject Matter Expert (SME) to internal departments (Vendor Management) – such as responding to vendor questions, WQ surveillance.Formulates recommendations for education and gives in-service presentation to the Coding Specialists as needed.Monitors and filters information that provides updates on regulatory changes that may impact coding.Researches information for departmental and interdepartmental staff on coding topics or other clinical information needed in a timely manner.May be asked to code in production coding work queues relevant to the Technical Advisor role and/or skill set as needed.May be assigned to train and audit Coding Specialists in various work-types.Supports and assists the Coding leadership with all assignments as requested.QualificationsEducation and Experience RequiredAS or BS in Health Information Technology/Administration or related health care administration required. ICD-10-CM and CPT-4/HCPCS education required.3+ years of broad ranged coding experience including extensive ICD-10-CM, CPT-4/HCPCS, outpatient coding guidelines and payor policies is required. Strong outpatient coding claim edit, and denial experience is required. Experience at an academic medical center is preferred.Data and Analytics experience is preferred. Supervisor/Auditor/Trainer experience is preferred.Certification/Credentials RequiredAHIMA RHIT or RHIA credentials are strongly preferred.Coding credentials from AAPC or AHIMA is required and may include CCS, CCS-P CCA, CPC, COC. AHIMA and/or AAPC credential maintenance is required through Continuing Education Units (CEU). Skills/Abilities/Competencies Required Extensive experience with computer systems including Coding and clinical data/billing systems. EPIC and 3M experience (preferred).Extensive Microsoft office experience, especially Word, Excel, PowerPoint.Excellent communication and interpersonal skills for remote teamwork.Ability to complete projects within presented timelines and deadlines.Ability to manage multiple projects and tasks.Strong analytical skills.Ability to work independently yet remain a team player.Working ConditionsExtensive use of computer equipment and software including Outlook and Teams.Frequent interaction with staff across all levels of the organization.Low physical effortOccasional bending, stooping, kneeling, crouching and/or reaching.Travel to Assembly Row may be required.Job Field: CodingOrganization: Mass General BrighamSchedule: Full-timeShift: Day JobEmployee Status: Regular