Boston Medical Center (BMC)
Overview
Coding Education Specialist
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Boston Medical Center (BMC) Position summary outlines responsibilities for the operational functions of the Professional Coding Operations team for BUMG. The role validates the accuracy of CPT, HCPCS and diagnosis code assignment by coders, physicians and non‑physician practitioners, works with revenue cycle stakeholders on denials and root cause analysis, supervises coding staff, and partners with the Coding Education Team to identify trends and develop feedback and education for providers. The role involves reviewing coding denials, conducting quality assurance on inpatient and outpatient records, and providing in‑service training and updates to coding staff. Oversees coding operations to meet organizational goals and ensures compliance with payer guidelines and Official Coding Rules.
Responsibilities
Primary responsibilities under the direction of the Director, PB Coding Operations. Coding support:
Review patient medical records and abstract medical data identifying diagnoses and procedures. Code diagnoses, procedures, and modifiers using ICD-10-CM, CPT4/HCPCS; use encoding aids and reference materials to ensure accurate coding for billing. Sequence diagnoses and procedures following ICD-10-CM, CPT-4 and UHDDS; adhere to Official Guidelines for Coding and Reporting, Coding Clinic guidelines and other regulatory guidelines; consult with appropriate medical staff for clarification. Maintain productivity standards per departmental policies; serve as contact for professional billing coders regarding missing/incomplete information. Maintain knowledge of coding and professional skills, including credentialing through in‑service programs, conferences, and literature reviews. Orient new personnel in department coding procedures; monitor coding queues to ensure targets are met. Review coding denials to resolve issues, identify trends, and provide feedback to providers and departments. Perform quality assurance reviews of inpatient and outpatient records to assess training program effectiveness and coder quality; provide in‑service training and updates on coding changes. Oversee coding operations to ensure organizational goals are met; design and implement programs on coding and clinical documentation audit and education to improve performance and efficiency. Enforce correct application of Official Coding Rules and Regulations; monitor coding edits and denials to ensure payer guideline compliance. Support RAC and other external coding reviews and denials related to coding. General
Manage day‑to‑day PB Coding Operations Team activities; develop and mentor certified professional coders. Handle interviewing, orientation, training, evaluations; hire, terminate and discipline personnel as necessary. Establish staffing, scheduling and workload assignments; assist with coding professional claims under supervision of the PB Coding Operations Team. Conduct quality reviews to validate code selection against guidelines; evaluate documentation for completeness or consistency impacting code assignment. Initiate queries when necessary and monitor responses; provide training to healthcare professionals, coders and Revenue Cycle staff on ICD, CPT, HCPCS Level II coding guidelines and documentation requirements. Develop long‑term strategies to improve efficiencies and coding team productivity through standardized conventions; mentor and educate stakeholders across Revenue Cycle. Report on coding and abstracting accuracy; track coding accountability with internal/external sources (e.g., RAC, payer reviews). Monitor overtime, attendance and staffing metrics; review timesheets and payroll related activities. Maintain knowledge of ICD‑10 and CPT classifications; participate in coding and reimbursement meetings; follow infection control and safety procedures; share knowledge with staff. Education
Bachelor’s degree or equivalent combination of education and experience. Certificates, Licenses, Registrations
CPC – Certified Professional Coder Experience
Minimum five years of coding experience including education/mentoring/training; five years acute care hospital coding with ICD‑10‑CM and CPT‑4; experience in academic medical setting or trauma center preferred. Minimum of three years management experience; five years preferred. Prior experience with claim edits and denials. Knowledge And Skills
Excellent knowledge of ICD‑10‑CM and CPT4/HCPCS coding conventions, E&M coding; understanding of anatomy, physiology and pathology. Proven ability to provide hands‑on education to coding staff based on audits and needs. Strong knowledge of health records, billing systems, Microsoft applications, data integrity and processing techniques. Excellent organizational skills, multi‑tasking, prioritization and adherence to timelines; high attention to detail; problem solving using current policies. Ability to work with diverse healthcare team, handle interruptions and respond to urgent requests; maintain strict confidentiality per HIPAA regulations. Extensive knowledge of payer claim edits and denials; deep understanding of terminology and coding regulations including CMS NCDs. Ability to mentor, guide and motivate direct reports; ability to lead by example and share knowledge across the team and stakeholders. Compensation
Range: $58,000.00 – $84,000.00; note that compensation is based on education, experience, skills and certifications, with additional benefits and opportunities as described by BMCHS. Equal Opportunity
Equal Opportunity Employer/Disabled/Veterans. The organization notes awareness of employment offer scams and provides guidance on legitimate application processes.
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Coding Education Specialist
at
Boston Medical Center (BMC) Position summary outlines responsibilities for the operational functions of the Professional Coding Operations team for BUMG. The role validates the accuracy of CPT, HCPCS and diagnosis code assignment by coders, physicians and non‑physician practitioners, works with revenue cycle stakeholders on denials and root cause analysis, supervises coding staff, and partners with the Coding Education Team to identify trends and develop feedback and education for providers. The role involves reviewing coding denials, conducting quality assurance on inpatient and outpatient records, and providing in‑service training and updates to coding staff. Oversees coding operations to meet organizational goals and ensures compliance with payer guidelines and Official Coding Rules.
Responsibilities
Primary responsibilities under the direction of the Director, PB Coding Operations. Coding support:
Review patient medical records and abstract medical data identifying diagnoses and procedures. Code diagnoses, procedures, and modifiers using ICD-10-CM, CPT4/HCPCS; use encoding aids and reference materials to ensure accurate coding for billing. Sequence diagnoses and procedures following ICD-10-CM, CPT-4 and UHDDS; adhere to Official Guidelines for Coding and Reporting, Coding Clinic guidelines and other regulatory guidelines; consult with appropriate medical staff for clarification. Maintain productivity standards per departmental policies; serve as contact for professional billing coders regarding missing/incomplete information. Maintain knowledge of coding and professional skills, including credentialing through in‑service programs, conferences, and literature reviews. Orient new personnel in department coding procedures; monitor coding queues to ensure targets are met. Review coding denials to resolve issues, identify trends, and provide feedback to providers and departments. Perform quality assurance reviews of inpatient and outpatient records to assess training program effectiveness and coder quality; provide in‑service training and updates on coding changes. Oversee coding operations to ensure organizational goals are met; design and implement programs on coding and clinical documentation audit and education to improve performance and efficiency. Enforce correct application of Official Coding Rules and Regulations; monitor coding edits and denials to ensure payer guideline compliance. Support RAC and other external coding reviews and denials related to coding. General
Manage day‑to‑day PB Coding Operations Team activities; develop and mentor certified professional coders. Handle interviewing, orientation, training, evaluations; hire, terminate and discipline personnel as necessary. Establish staffing, scheduling and workload assignments; assist with coding professional claims under supervision of the PB Coding Operations Team. Conduct quality reviews to validate code selection against guidelines; evaluate documentation for completeness or consistency impacting code assignment. Initiate queries when necessary and monitor responses; provide training to healthcare professionals, coders and Revenue Cycle staff on ICD, CPT, HCPCS Level II coding guidelines and documentation requirements. Develop long‑term strategies to improve efficiencies and coding team productivity through standardized conventions; mentor and educate stakeholders across Revenue Cycle. Report on coding and abstracting accuracy; track coding accountability with internal/external sources (e.g., RAC, payer reviews). Monitor overtime, attendance and staffing metrics; review timesheets and payroll related activities. Maintain knowledge of ICD‑10 and CPT classifications; participate in coding and reimbursement meetings; follow infection control and safety procedures; share knowledge with staff. Education
Bachelor’s degree or equivalent combination of education and experience. Certificates, Licenses, Registrations
CPC – Certified Professional Coder Experience
Minimum five years of coding experience including education/mentoring/training; five years acute care hospital coding with ICD‑10‑CM and CPT‑4; experience in academic medical setting or trauma center preferred. Minimum of three years management experience; five years preferred. Prior experience with claim edits and denials. Knowledge And Skills
Excellent knowledge of ICD‑10‑CM and CPT4/HCPCS coding conventions, E&M coding; understanding of anatomy, physiology and pathology. Proven ability to provide hands‑on education to coding staff based on audits and needs. Strong knowledge of health records, billing systems, Microsoft applications, data integrity and processing techniques. Excellent organizational skills, multi‑tasking, prioritization and adherence to timelines; high attention to detail; problem solving using current policies. Ability to work with diverse healthcare team, handle interruptions and respond to urgent requests; maintain strict confidentiality per HIPAA regulations. Extensive knowledge of payer claim edits and denials; deep understanding of terminology and coding regulations including CMS NCDs. Ability to mentor, guide and motivate direct reports; ability to lead by example and share knowledge across the team and stakeholders. Compensation
Range: $58,000.00 – $84,000.00; note that compensation is based on education, experience, skills and certifications, with additional benefits and opportunities as described by BMCHS. Equal Opportunity
Equal Opportunity Employer/Disabled/Veterans. The organization notes awareness of employment offer scams and provides guidance on legitimate application processes.
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