The mission of MassHealth is to improve the health outcomes of our diverse members, their families and their communities by providing access to integrated health care services that sustainably promote health, well-being, independence and quality of life.

Duties and Responsibilities (these duties are a general summary and not all Inclusive) :

* Provide clinical coding expertise assuring that the ICD-10 CM/PCS code set and other coding is implemented in a consistent, justifiable manner.
* Review clinical documentation and diagnostic results to extract data, and apply the appropriate ICD-CM/PCS and CPT-4 codes for billing, internal and external reporting, research, and regulatory compliance. Codes inpatient and outpatient conditions and procedures as documented in ICD-CM Official Guidelines for Coding and Reporting.
* Resolve errors associated with billing and claims processing; identify and report error patterns; and design workflow changes to reduce errors.
* Coordinate and facilitate annual code updates with program staff.
* Assist in reviewing and validating MMIS ICD-10 modifications.
* Coordinate with program and operations staff, and MMIS IT to update, and maintain ICD logic; and help resolve mapping discrepancies.
* Reviews provider documentation to determine principal diagnosis, co-morbidities and complications, secondary conditions and surgical procedures. Resolve questions with provider.
* Verify and abstract specific clinical and demographic data, APR-DRG assignment, and APG/EAPG outpatient assignment.
* Assure appropriate diagnosis and grouper assignment. Extract required information from source documentation and enter into system.
* Identify and report non-payment Provider Preventable Conditions (PPC).
* Review error reports; correct or complete missing data elements.
* Act as a resource for staff on coding issues, monitor changes in regulations that impact clinical documentations, reimbursement and coding and disseminate changes in coding rules.
* Ensure that computer systems are updated with annual code changes and updates.
* Produce clinical data and statistical reports for clinicians, researchers, financial and business planning, and clinical quality support services.
* Review training and communications materials and billing instructions, and oversee staff training.

Preferred Qualifications :

* Three to five years of coding experience in a health care setting (i.e. hospital, large physician group practice, health plan, etc.)
* Bachelors Degree.
* Proficient in ICD-9-CM ICD-10-CM/PCS and CPT coding system, DRG,
APG,MS-DRG and APCs and official coding guidelines.
* Ability to plan and prepare for ICD-10CM/PCS updates.
* Knowledgeable in medical terminology, anatomy and physiology, abnormal lab results, disease processes, and pharmacology-drug names.
* Basic computer knowledge and familiarity with systems used in healthcare, proficiency with Microsoft Office.
* Excellent organizational and communication skills.
* Ability to work independently, and in a matrixed, team oriented, fast paced project environment.
* RHIA, RHIT, CCS, or CPC certification.

Special Requirements :

Based on assignment, possession of a current and valid Massachusetts Class D Motor Vehicle Operator s license or the equivalent from another state may be required.

Pre-Hire Process :

A criminal background check will be completed on the recommended candidate as required by the regulations set forth by the Executive Office of Health and Human Services prior to the candidate being hired. For more information, please visit
* Education, licensure and certifications will be verified in accordance with the Human Resources Division s Hiring Guidelines
Education and license/certification information provided by the selected candidate(s) is subject to the Massachusetts Public Records Law and may be published on the Commonwealth s website.
For questions, please contact the CYF Office of Human Resources at 1-800-###-#### and select option #2.
This requisition will remain open until filled; however, first consideration will be given to those applicants that apply within the first 14 days.

Applicants must have at least (A) four years of full-time, or equivalent part-time, professional, administrative or managerial experience in business administration, business management or public administration the major duties of which involved program management, program administration, program coordination, program planning and/or program analysis, and (B) of which at least one year must have been in a supervisory capacity, or (C) any equivalent combination of the required experience and the substitutions below.


I. A Bachelor's degree with a major in business administration, business management or public administration may be substituted for a maximum of two years of the required (A) experience.*
II. A Graduate degree with a major in business administration, business management or public administration may be substituted for a maximum of three years of the required (A) experience.**
III. A Bachelor's or higher degree with a major other than in business administration, business management or public administration may be substituted for a maximum of one year of the required (A) experience.*
*Education toward such a degree will be prorated on the basis of the proportion of the requirements actually completed.

No substitutions will be permitted for the required (B) experience.
An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.

** **Administrative Services*
**Organization:** **Exec Office Of Health and Human Services*
**Title:** *Medical Coder*
**Location:** *Massachusetts-Quincy - 100 Hancock Street*
**Requisition ID:** *170002OO*
Associated topics: account, accounts receivable, coder, data, data entry, desk, front desk, medical coding, number, receivable

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