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Inpatient Coding Quality & Education Specialist

Mass General Brigham (Enterprise Services)

Somerville, MA

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JOB DETAILS
SKILLS
Analysis Skills, Auditing, Automation, Benchmarking, Best Practices, Biomedical Research, Clinical Data, Clinical Study Publications, Clinical Support, Code Reviews, Community Health, Community and Social Services, Computer Software, Continuous Improvement, Corrective Action, Data Analysis, Data Quality, Diagnosis-Related Group (DRG), Diversity, Documentation, External Audit, Health Information Management, Healthcare Quality, Home Care, Hospital, ICD-10, Internal Audit, Leadership, Managed Care, Medical Coding, Mentoring, Nonprofit, Onboarding, Operational Audit, Operational Improvement, Operations Processes, Patient Care, Patient Safety, Performance Analysis, Performance Management, Process Improvement, Productivity Management, Project/Program Management, Quality Assurance, Quality Metrics, Quality Monitoring, Regulations, Regulatory Compliance, Reimbursement, Reporting Dashboards, Risk, Strategic Planning, Team Player, Training/Teaching, Training/Teaching Materials, Trend Analysis, Vendor/Supplier Evaluation, Willing to Travel, Workflow Analysis
LOCATION
Somerville, MA
POSTED
Today
About Us:
As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women's Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.

We're focused on a people-first culture for our system's patients and our professional family. That's why we provide our employees with more ways to achieve their potential. Mass General Brigham is committed to aligning our employees' personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development-and we recognize success at every step.

Our employees use the Mass General Brigham values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.

Position SummaryThe Inpatient Coding Quality & Education Specialist serves as a subject matter expert in ICD-10-CM/PCS coding, coding quality, clinical data integrity, and coding-related performance improvement initiatives. This role supports organizational goals related to coding accuracy, quality outcomes, reimbursement integrity, compliance, and operational efficiency through coder education, auditing, onboarding, data analysis, and collaboration with multidisciplinary stakeholders.The specialist partners closely with Coding Operations, Coding Quality, Clinical Documentation Integrity (CDI), Revenue Integrity, Quality, and other operational teams to identify trends, develop educational strategies, improve coding workflows, and support quality reporting methodologies including Vizient, Elixhauser, mortality, severity of illness (SOI), risk of mortality (ROM), expected length of stay, and other coding-sensitive measures.Key ResponsibilitiesCoding Quality & Audit Activities
  • Perform pre-bill and post-bill coding audits utilizing internal and third-party audit platforms and vendor software.
  • Review coded accounts for coding accuracy, reimbursement integrity, quality reporting implications, and compliance with coding guidelines.
  • Analyze audit findings to identify trends, educational opportunities, and systemic process improvement initiatives.
  • Collaborate with Coding Operations, Quality, CDI, Revenue Integrity, and Compliance teams to address identified findings and implement corrective actions.
  • Track, trend, and report audit outcomes to leadership and operational stakeholders.
  • Support external audit preparedness and validation activities, including payer, regulatory, and vendor reviews.Education & Training
    • Lead onboarding and competency development for newly hired inpatient coders or Data Quality Specialist.
    • Develop and deliver coding education related to ICD-10-CM, ICD-10-PCS, Official Coding Guidelines, Coding Clinic advice, regulatory updates, and organizational policies.
    • Create educational materials, tip sheets, job aids, presentations, and learning resources.
    • Facilitate individual and group education sessions based on audit findings, quality trends, and operational needs.
    • Support ongoing professional development and coding competency initiatives.Quality & Clinical Data Integrity Support
      • Collaborate with quality, CDI, and operational teams to evaluate coding impacts on quality reporting and benchmarking methodologies.
      • Analyze coding opportunities affecting Vizient, Elixhauser, mortality, severity of illness, risk of mortality, expected length of stay, patient safety indicators, hospital-acquired conditions, and other coding-sensitive measures.
      • Assist in identifying opportunities to improve data integrity through accurate code assignment and documentation interpretation.
      • Support coding-related initiatives that impact organizational quality performance and external reporting.Operational Improvement & Workflow Optimization
        • Partner with Coding Operations and leadership to identify workflow efficiencies and process improvement opportunities.
        • Provide recommendations regarding coding work queues, system edits, automation opportunities, workflow design, and operational controls.
        • Assist in developing and monitoring coding quality metrics, dashboards, and performance indicators.
        • Participate in enterprise projects related to coding quality, compliance, education, and operational effectiveness.
        • Evaluate trends and provide recommendations to improve productivity, accuracy, and consistency.Leadership Support & Consultation
          • Serve as a coding subject matter expert for inpatient coding-related questions and initiatives.
          • Provide consultative support to leadership regarding coding trends, audit findings, education needs, and performance improvement opportunities.
          • Assist leaders with action planning, performance monitoring, and implementation of corrective actions when appropriate.
          • Support organizational readiness for coding guideline updates, regulatory changes, and system implementations.Compliance & Regulatory Support
            • Promote adherence to Official Coding Guidelines, Coding Clinic guidance, payer requirements, and organizational policies.
            • Assist with coding compliance reviews and remediation activities.
            • Maintain current knowledge of regulatory changes, coding updates, and industry best practices.
            • Support audit preparedness and coding compliance initiatives across the organization.Required Qualifications
              • Associate's degree in Health Information Management or related field (Bachelor's preferred)
              • RHIA, RHIT, CCS, or equivalent credential required
              • 5 years of progressively responsible inpatient coding experience
              • 2 years of coding quality, auditing, education, mentoring, or leadership experience
              • Advanced knowledge of ICD-10-CM/PCS, MS-DRG assignment, Official Coding Guidelines, Coding Clinic, and reimbursement methodologiesPreferred
                • 7-10 years of inpatient coding experience
                • Experience onboarding and mentoring coders
                • Experience conducting coding audits and developing education plans
                • Experience supporting quality reporting methodologies (Vizient, Elixhauser, PSI/HAC, SOI/ROM, mortality, expected LOS)
                • Experience with Epic, Solventum/3M, encoder and auditing platforms
                • Lean, process improvement, or project management experienceWorking Conditions:
                  • Extensive use of computer equipment and software
                  • Frequent interaction with staff across all levels of the organization
                  • Low physical effort
                  • Occasional bending, stooping, kneeling, crouching and/or reaching.
                  • Remote workers considered but may require limited travel to corporate office.

                    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.

About the Company

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Mass General Brigham (Enterprise Services)