Job Details

Health Information Management Specialist

Hours: 40 hours per week. Monday through Friday. Location: 100% remote. This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing. In addition, this role focuses on performing the following Health Information Management duties: Responsible for the accuracy, maintenance, security, and confidentiality of patient's health information. An organizational related support or service (administrative or clerical) role or a role that focuses on support of daily business activities (e.g., technical, clinical, non-clinical) operating in a "hands on" environment. The majority of time is spent in the delivery of support services or activities, typically under supervision. A senior level role that requires broad knowledge of operational procedures and tools obtained through extensive work experience and may require vocational or technical education. Works under limited supervision for routine situations, provides assistance and training to lower level employees, and problems typically are not routine and require analysis to understand.

Job Overview

This position reviews medical records to assure accurate specificity of diagnoses and procedures for inpatient admissions. Effectively utilizes ICD-10 CM and PCS codes according to coding guidelines. Communicates effectively with providers and/or all appropriate staff regarding missing information such as diagnosis, procedure, and documentation issues, to ensure proper coding and reimbursement. Manages the creation of deficiencies, within Epic, for missing documentation. Works with leadership to review denial reports as well as participating in internal and external audits to ensure documentation, code capture, and billing are accurate and precise. Informs supervisor of unusual/problematic accounts, issues, concerns, and opportunities for improvement. Attends meetings and education sessions as requested with participation. Performs any other related duties as assigned.

Job Description

Minimum Qualifications:

• High school diploma or equivalent.
• Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC), Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT).
• Three (3) years of ICD-10-CM and PCS coding experience.
• EMR experience.

Preferred Qualifications:

• Associates degree.
• Five (5) years of Inpatient ICD-10-CM and PCS coding experience within a Teaching hospital or Level One Trauma Center.
• Epic and CAC Experience.

Duties and Responsibilities

The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list. Other duties and responsibilities may be assigned.

• Verifies and abstracts clinical and demographic data from the patient record.
• Performs chart audits prior to coding to ensure required documentation is complete and signed. Queries appropriate providers or departments when deficiencies prevent the start of the coding process.
• Assigns accurately ICD-10 CM and ICD10 PCS codes, derived from medical record documentation for patient account.
• Reviews reports with leadership to identify discrepancies.
• Reviews audit lists regarding coding/billing changes, as well as denial reports.
• Identifies and evaluates coding issues, summarizes findings for leadership, makes recommendations for course of action. Works actively with physicians to initiate corrections and resolve discrepancies in coding and documentation.
• Ensures that all accounts are submitted accurately and in a timely manner.
• Works collaboratively with Compliance, Educators, and Auditors.
• Ensures that all medical records are coded and abstracted within 72 hours of patient discharge.
• Responsible to follow-up on assigned discharges for final coding.
• Acts as a resource for answering coding questions from interdepartmental staff.
• Documents results of all special project work and providing recommendations relating to special projects.
• Attend meetings as necessary and participates on projects to ensure that all services are captured through codes.
• Maintains good relationship with providers and office personnel to facilitate good communication in coding queries.
• Promote excellent customer service. Identify and communicate problems and/or opportunities to improve processes with management.
• Maintains collaborative, team relationships with peers and colleagues in order to effectively contribute to the working groups achievement of goals, and to help foster a positive work environment.
• Performs job junctions adhering to service principles with customer service focus of innovation, service excellence and teamwork to provide the highest quality care and service to our patients, families, colleagues and community.
• Participates in coding audits coding staff in order to maintain quality standards and offer feedback to management.
• Works closely with the DRG Validator to maintain high coding standards.

Physical Requirements

1. Sedentary role which requires sitting most of the time, occasional standing & walking. Mental requirements will be intense at times with involvement in many concurrent multi-faceted projects. 2. Manual dexterity using fine hand manipulation to operate computer keyboard. 3. Ability to see computer screen and reports.

Skills & Abilities

1. Excellent organizational skills and able to balance working on multiple tasks and provide timely follow through. 2. Effective interpersonal and communication skills. 3. Ability to work under pressure and meet deadlines. 4. Ability to communicate verbally, by phone or virtually, with colleagues and medical staff. 5. Knowledge of Excel and basic computer skills. 6. Working knowledge of ICD- 10-CM, ICD 10- PCS, and CPT coding system, DRG, APG, Government and Commercial payor policies, Coding Clinic, disease processes, medical terminology, anatomy and physiology. 7. Ability to read and write in the English language.

Tufts Medicine is a leading integrated health system bringing together the best of academic and community healthcare to deliver exceptional, connected and accessible care experiences to consumers across Massachusetts. Comprised of Tufts Medical Center, Lowell General Hospital, MelroseWakefield Hospital, Lawrence Memorial Hospital of Medford, Care at Home - an expansive home care network, and large integrated physician network. We are an equal opportunity employer and value diversity and inclusion at Tufts Medicine. Tufts Medicine does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status or any other characteristic protected by federal, state or local law. We will ensure that individuals with disabilities are provided 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. Please contact us to request accommodation by emailing us at ...@tuftsmedicine.org.