5,022 Coding jobs in South Africa

An amazing opportunity has become available for candidates that want to join a people centric growing business as a Data Analyst Duties & Responsibilities

Objectives of the Role

• Ensure that DMA, RNG and GET tasks allocated for testing are assessed and reported on in accordance with the approved methodologies, working documents and templates and in line with regulatory, accreditation and contractual requirements.
• Ensure data generation and conversion are assessed and sufficient for testing for game engine testing.

Primary Responsibilities

• Conduct Game Engine Testing (GET) for all product and game types.
• Conduct data generation as per agreed criteria with client.
• Conduct Random Number Generator (RNG) testing in line with requirements.
• Conduct Data Monitoring and Analysis (DMA) as per the agreed frequency per client.
• Maintain spreadsheet models to perform the required reviews.
• Review and evaluate analytical results to ensure they meet acceptable criteria.
• Reporting on status and test findings to supervisor.
• Liaise with department heads in aid of cooperation and resolution of issues.
• Knowledge of and familiarisation with general online gambling industry and gaming terminology.
• Understanding of and familiarisation with game types, variants and regulatory requirements.
• Understanding of and familiarisation with ISO/IEC 17020, 17025, 17065 and related documentation.
• Ensure all responsibilities are effectively and efficiently executed in accordance with company policies, procedures and processes.
• Ensure all required responsibilities of a jurisdictional manager as communicated in SOP are followed.
• Quality assurance - conduct self-reviews and peer reviews.
• Perform ad hoc tasks as and when required.

Desired Experience & Qualification

Job Specification

Qualification

• Mathematics/Science/Commerce/Computer Science Degree (NQF Level 7), or equivalent, if substantiated by valid evidence of competency.
• Computer Science major a required minimum.

Experience

• 2 years’ relevant programming experience in a professional working environment.
• Programming in any of the following languages: C, C++, C#, Java, Json, Go, Python and R.

#J-18808-Ljbffr

# **.***Exemption Status:**Exempt**Schedule Details:**Monday through Friday**Scheduled Hours:**7:00 a.m. - 3:30 p.m.**Shift:**1 - Day Shift, 8 Hours (United States of America)**Hours:**40**Cost Center:**99940 - 5458 Coding ServicesThis position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.# # **Everyone Is a Caregiver**At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.Performs focused account and quality reviews of coded records to support the ongoing performance management process. Validates the Diagnosis Related Group (DRG) and current editions of ICD-CM, ICD-PCS, and CPT code assignment to ensure consistency and efficiency in the processing, data collection, and quality reporting associated with inpatient and outpatient claims.I. Major Responsibilities:1. Performs focused account and Coder quality reviews on inpatient and outpatient records to validate the DRG and current editions of ICD-CM, ICD-PCS, and CPT code assignment as well as missed secondary diagnoses or procedures which may impact the Severity of Illness (SOI) and Risk of Mortality (ROM). 2. Ensures compliance with all DRG, outpatient coding, and charging mandates as well as reporting requirements. 3. Validates the DRG and current editions of ICD-CM, ICD-PCS, and CPT code assignment to ensure consistency and efficiency in the processing, data collection, and quality reporting associated with inpatient and outpatient claims. 4. Demonstrates competency in the use of computer applications, DRG grouper software, as well as all coding and abstracting software currently used in HIM. 5. Runs daily reports to ensure all focused account reviews are worked to prevent the unnecessary holding of accounts prior to billing. Informs the Manager of Coding-HIM when backlog situations arise and necessary documents are either incorrect or not received in a timely manner. 6. Provides feedback on Coder quality reviews to the Manager of Coding-HIM, Supervisor of Inpatient Coding, Manager of Emergency Department (ED) Coding, and Manager of Radiology Coding based on the Coding Audit and Performance Management policy and procedure. 7. Creates and monitors Case Mix Index (CMI) reports and accuracy of the top 25 assigned DRGs to identify patterns, trends, and variations. 8. Creates and monitors outpatient reports and accuracy of top 25 assigned principle diagnoses to identify patterns, trends, and variations in the organization’s frequently assigned principle diagnoses, evaluation and management codes, modifiers, and CPT procedure changes. 9. Evaluates the root cause of any identified trends or possible problem areas. Reports variances to the Manager of Coding-HIM, Manager of ED Coding, and Manager of Radiology Coding. 10. Acts as a point person for Coding staff on questions or concerns related to ICD-CM (current edition), DRG, Evaluation and Management (E/M) code assignment as well as procedural coding and the retrospective query process. 11. Maintains direct and ongoing communications with Coding personnel to maximize overall effectiveness and efficiency of Coding operations. 12. Informs Manager(s) of any coding irregularities or trends contrary to policies / procedures and communicates with appropriate staff if necessary. 13. Assists the Manager of Coding-HIM in performance improvement initiatives and demonstrates the use of quality improvement in daily operations. 14. Assists the Manager of Coding-HIM in meeting department / unit goals and ensuring compliance with regulatory agencies such as Joint Commission, DPH, etc. 15. Works closely with the Retrospective CDIS Nurse and Clinical Documentation Improvement (CDI) Program team to continuously monitor the quality of clinical documentation to identify incomplete or inconsistent documentation in addition to any changes in DRG assignment and payment. 16. Monitors retrospective queries for appropriateness and may provide Coder feedback. Informs the Manager of Coding-HIM of any identified concerns. 17. Collaborates with the Manager of Coding-HIM as the primary department resource for the dissemination of DRG interpretations. 18. Collaborates with the Coding Educator to provide ongoing education to the Coding staff, Providers, and other clinicians to ensure appropriate assignment of current edition of ICD-CM, DRGs, E/M codes as well as modifiers and CPT procedure changes. 19. Collaborates with the Coding Educator to incorporate improvement efforts into coding in-services throughout the year. 20. Assists the Manager of Coding-HIM in preparing productivity reports and participates in the department’s total quality management studies. 21. Maintains DRG and coding accuracy rate of not less than 95% for optimal reimbursement as well as department productivity standards as outlined in department policies. 22. Attends required training classes and coding in-services each year to stay abreast of new regulations and coding guidelines. 23. Participates in improvement efforts and documentation training for medical and clinical staff as it relates to coding practices and guidelines. 24. Monitors Medicare and other DRG payer bulletins and manuals. Reviews current Office of Inspector General (OIG) work plans for DRG risk areas. 25. Keeps current with all coding updates and information related to correct coding.Standard Staffing Level Responsibilities:1. Complies with established departmental policies, procedures and objectives. 2. Attends variety of meetings, conferences, seminars as required or directed. 3. Demonstrates use of Quality Improvement in daily operations. 4. Complies with all health and safety regulations and requirements. 5. Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors. 6. Maintains, regular, reliable, and predictable attendance. 7. Performs other similar and related duties as required or directed.All responsibilities are essential job functions.II. Position Qualifications:License/Certification/Education: Required: 1. Bachelor’s degree in Business or Health Care Administration. 2. Certification as a Certified Coding Specialist (CCS).Preferred: 1. Certification as a Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT).Experience/Skills: Required: 1. Minimum of five (5) years of experience coding in a large, teaching, acute tertiary care setting with demonstrated coding expertise. 2. Extensive knowledge of current editions of DRGs, ICD-CM, ICD-PCS, and CPT coding systems. 3. Through knowledge of third-party payer requirements as well as federal and state guidelines and regulations pertaining to coding and billing practices. 4. General knowledge of hospital information systems as well as extensive knowledge of computer systems / applications used in HIM. 5. General knowledge of the retrospective CDI query process as well as guidelines for achieving a compliant query and associated compliance concerns. 6. Excellent customer service skills with the ability to communicate efficiently. 7. Exceptional organizational skills with attention to detail. 8. Ability to lead, organize, and support the work of less senior Coders is a primary function of this
#J-18808-Ljbffr

# **.***Exemption Status:**Exempt**Schedule Details:**Monday through Friday**Scheduled Hours:**7:00 a.m. - 3:30 p.m.**Shift:**1 - Day Shift, 8 Hours (United States of America)**Hours:**40**Cost Center:**99940 - 5458 Coding ServicesThis position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.# # **Everyone Is a Caregiver**At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.Performs focused account and quality reviews of coded records to support the ongoing performance management process. Validates the Diagnosis Related Group (DRG) and current editions of ICD-CM, ICD-PCS, and CPT code assignment to ensure consistency and efficiency in the processing, data collection, and quality reporting associated with inpatient and outpatient claims.I. Major Responsibilities:1. Performs focused account and Coder quality reviews on inpatient and outpatient records to validate the DRG and current editions of ICD-CM, ICD-PCS, and CPT code assignment as well as missed secondary diagnoses or procedures which may impact the Severity of Illness (SOI) and Risk of Mortality (ROM). 2. Ensures compliance with all DRG, outpatient coding, and charging mandates as well as reporting requirements. 3. Validates the DRG and current editions of ICD-CM, ICD-PCS, and CPT code assignment to ensure consistency and efficiency in the processing, data collection, and quality reporting associated with inpatient and outpatient claims. 4. Demonstrates competency in the use of computer applications, DRG grouper software, as well as all coding and abstracting software currently used in HIM. 5. Runs daily reports to ensure all focused account reviews are worked to prevent the unnecessary holding of accounts prior to billing. Informs the Manager of Coding-HIM when backlog situations arise and necessary documents are either incorrect or not received in a timely manner. 6. Provides feedback on Coder quality reviews to the Manager of Coding-HIM, Supervisor of Inpatient Coding, Manager of Emergency Department (ED) Coding, and Manager of Radiology Coding based on the Coding Audit and Performance Management policy and procedure. 7. Creates and monitors Case Mix Index (CMI) reports and accuracy of the top 25 assigned DRGs to identify patterns, trends, and variations. 8. Creates and monitors outpatient reports and accuracy of top 25 assigned principle diagnoses to identify patterns, trends, and variations in the organization’s frequently assigned principle diagnoses, evaluation and management codes, modifiers, and CPT procedure changes. 9. Evaluates the root cause of any identified trends or possible problem areas. Reports variances to the Manager of Coding-HIM, Manager of ED Coding, and Manager of Radiology Coding. 10. Acts as a point person for Coding staff on questions or concerns related to ICD-CM (current edition), DRG, Evaluation and Management (E/M) code assignment as well as procedural coding and the retrospective query process. 11. Maintains direct and ongoing communications with Coding personnel to maximize overall effectiveness and efficiency of Coding operations. 12. Informs Manager(s) of any coding irregularities or trends contrary to policies / procedures and communicates with appropriate staff if necessary. 13. Assists the Manager of Coding-HIM in performance improvement initiatives and demonstrates the use of quality improvement in daily operations. 14. Assists the Manager of Coding-HIM in meeting department / unit goals and ensuring compliance with regulatory agencies such as Joint Commission, DPH, etc. 15. Works closely with the Retrospective CDIS Nurse and Clinical Documentation Improvement (CDI) Program team to continuously monitor the quality of clinical documentation to identify incomplete or inconsistent documentation in addition to any changes in DRG assignment and payment. 16. Monitors retrospective queries for appropriateness and may provide Coder feedback. Informs the Manager of Coding-HIM of any identified concerns. 17. Collaborates with the Manager of Coding-HIM as the primary department resource for the dissemination of DRG interpretations. 18. Collaborates with the Coding Educator to provide ongoing education to the Coding staff, Providers, and other clinicians to ensure appropriate assignment of current edition of ICD-CM, DRGs, E/M codes as well as modifiers and CPT procedure changes. 19. Collaborates with the Coding Educator to incorporate improvement efforts into coding in-services throughout the year. 20. Assists the Manager of Coding-HIM in preparing productivity reports and participates in the department’s total quality management studies. 21. Maintains DRG and coding accuracy rate of not less than 95% for optimal reimbursement as well as department productivity standards as outlined in department policies. 22. Attends required training classes and coding in-services each year to stay abreast of new regulations and coding guidelines. 23. Participates in improvement efforts and documentation training for medical and clinical staff as it relates to coding practices and guidelines. 24. Monitors Medicare and other DRG payer bulletins and manuals. Reviews current Office of Inspector General (OIG) work plans for DRG risk areas. 25. Keeps current with all coding updates and information related to correct coding.Standard Staffing Level Responsibilities:1. Complies with established departmental policies, procedures and objectives. 2. Attends variety of meetings, conferences, seminars as required or directed. 3. Demonstrates use of Quality Improvement in daily operations. 4. Complies with all health and safety regulations and requirements. 5. Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors. 6. Maintains, regular, reliable, and predictable attendance. 7. Performs other similar and related duties as required or directed.All responsibilities are essential job functions.II. Position Qualifications:License/Certification/Education: Required: 1. Bachelor’s degree in Business or Health Care Administration. 2. Certification as a Certified Coding Specialist (CCS).Preferred: 1. Certification as a Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT).Experience/Skills: Required: 1. Minimum of five (5) years of experience coding in a large, teaching, acute tertiary care setting with demonstrated coding expertise. 2. Extensive knowledge of current editions of DRGs, ICD-CM, ICD-PCS, and CPT coding systems. 3. Through knowledge of third-party payer requirements as well as federal and state guidelines and regulations pertaining to coding and billing practices. 4. General knowledge of hospital information systems as well as extensive knowledge of computer systems / applications used in HIM. 5. General knowledge of the retrospective CDI query process as well as guidelines for achieving a compliant query and associated compliance concerns. 6. Excellent customer service skills with the ability to communicate efficiently. 7. Exceptional organizational skills with attention to detail. 8. Ability to lead, organize, and support the work of less senior Coders is a primary function of this
#J-18808-Ljbffr

# **.***Exemption Status:**Exempt**Schedule Details:**Monday through Friday**Scheduled Hours:**7:00 a.m. - 3:30 p.m.**Shift:**1 - Day Shift, 8 Hours (United States of America)**Hours:**40**Cost Center:**99940 - 5458 Coding ServicesThis position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.# # **Everyone Is a Caregiver**At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.Performs focused account and quality reviews of coded records to support the ongoing performance management process. Validates the Diagnosis Related Group (DRG) and current editions of ICD-CM, ICD-PCS, and CPT code assignment to ensure consistency and efficiency in the processing, data collection, and quality reporting associated with inpatient and outpatient claims.I. Major Responsibilities:1. Performs focused account and Coder quality reviews on inpatient and outpatient records to validate the DRG and current editions of ICD-CM, ICD-PCS, and CPT code assignment as well as missed secondary diagnoses or procedures which may impact the Severity of Illness (SOI) and Risk of Mortality (ROM). 2. Ensures compliance with all DRG, outpatient coding, and charging mandates as well as reporting requirements. 3. Validates the DRG and current editions of ICD-CM, ICD-PCS, and CPT code assignment to ensure consistency and efficiency in the processing, data collection, and quality reporting associated with inpatient and outpatient claims. 4. Demonstrates competency in the use of computer applications, DRG grouper software, as well as all coding and abstracting software currently used in HIM. 5. Runs daily reports to ensure all focused account reviews are worked to prevent the unnecessary holding of accounts prior to billing. Informs the Manager of Coding-HIM when backlog situations arise and necessary documents are either incorrect or not received in a timely manner. 6. Provides feedback on Coder quality reviews to the Manager of Coding-HIM, Supervisor of Inpatient Coding, Manager of Emergency Department (ED) Coding, and Manager of Radiology Coding based on the Coding Audit and Performance Management policy and procedure. 7. Creates and monitors Case Mix Index (CMI) reports and accuracy of the top 25 assigned DRGs to identify patterns, trends, and variations. 8. Creates and monitors outpatient reports and accuracy of top 25 assigned principle diagnoses to identify patterns, trends, and variations in the organization’s frequently assigned principle diagnoses, evaluation and management codes, modifiers, and CPT procedure changes. 9. Evaluates the root cause of any identified trends or possible problem areas. Reports variances to the Manager of Coding-HIM, Manager of ED Coding, and Manager of Radiology Coding. 10. Acts as a point person for Coding staff on questions or concerns related to ICD-CM (current edition), DRG, Evaluation and Management (E/M) code assignment as well as procedural coding and the retrospective query process. 11. Maintains direct and ongoing communications with Coding personnel to maximize overall effectiveness and efficiency of Coding operations. 12. Informs Manager(s) of any coding irregularities or trends contrary to policies / procedures and communicates with appropriate staff if necessary. 13. Assists the Manager of Coding-HIM in performance improvement initiatives and demonstrates the use of quality improvement in daily operations. 14. Assists the Manager of Coding-HIM in meeting department / unit goals and ensuring compliance with regulatory agencies such as Joint Commission, DPH, etc. 15. Works closely with the Retrospective CDIS Nurse and Clinical Documentation Improvement (CDI) Program team to continuously monitor the quality of clinical documentation to identify incomplete or inconsistent documentation in addition to any changes in DRG assignment and payment. 16. Monitors retrospective queries for appropriateness and may provide Coder feedback. Informs the Manager of Coding-HIM of any identified concerns. 17. Collaborates with the Manager of Coding-HIM as the primary department resource for the dissemination of DRG interpretations. 18. Collaborates with the Coding Educator to provide ongoing education to the Coding staff, Providers, and other clinicians to ensure appropriate assignment of current edition of ICD-CM, DRGs, E/M codes as well as modifiers and CPT procedure changes. 19. Collaborates with the Coding Educator to incorporate improvement efforts into coding in-services throughout the year. 20. Assists the Manager of Coding-HIM in preparing productivity reports and participates in the department’s total quality management studies. 21. Maintains DRG and coding accuracy rate of not less than 95% for optimal reimbursement as well as department productivity standards as outlined in department policies. 22. Attends required training classes and coding in-services each year to stay abreast of new regulations and coding guidelines. 23. Participates in improvement efforts and documentation training for medical and clinical staff as it relates to coding practices and guidelines. 24. Monitors Medicare and other DRG payer bulletins and manuals. Reviews current Office of Inspector General (OIG) work plans for DRG risk areas. 25. Keeps current with all coding updates and information related to correct coding.Standard Staffing Level Responsibilities:1. Complies with established departmental policies, procedures and objectives. 2. Attends variety of meetings, conferences, seminars as required or directed. 3. Demonstrates use of Quality Improvement in daily operations. 4. Complies with all health and safety regulations and requirements. 5. Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors. 6. Maintains, regular, reliable, and predictable attendance. 7. Performs other similar and related duties as required or directed.All responsibilities are essential job functions.II. Position Qualifications:License/Certification/Education: Required: 1. Bachelor’s degree in Business or Health Care Administration. 2. Certification as a Certified Coding Specialist (CCS).Preferred: 1. Certification as a Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT).Experience/Skills: Required: 1. Minimum of five (5) years of experience coding in a large, teaching, acute tertiary care setting with demonstrated coding expertise. 2. Extensive knowledge of current editions of DRGs, ICD-CM, ICD-PCS, and CPT coding systems. 3. Through knowledge of third-party payer requirements as well as federal and state guidelines and regulations pertaining to coding and billing practices. 4. General knowledge of hospital information systems as well as extensive knowledge of computer systems / applications used in HIM. 5. General knowledge of the retrospective CDI query process as well as guidelines for achieving a compliant query and associated compliance concerns. 6. Excellent customer service skills with the ability to communicate efficiently. 7. Exceptional organizational skills with attention to detail. 8. Ability to lead, organize, and support the work of less senior Coders is a primary function of this
#J-18808-Ljbffr

# **.***Exemption Status:**Exempt**Schedule Details:**Monday through Friday**Scheduled Hours:**7:00 a.m. - 3:30 p.m.**Shift:**1 - Day Shift, 8 Hours (United States of America)**Hours:**40**Cost Center:**99940 - 5458 Coding ServicesThis position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.# # **Everyone Is a Caregiver**At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.Performs focused account and quality reviews of coded records to support the ongoing performance management process. Validates the Diagnosis Related Group (DRG) and current editions of ICD-CM, ICD-PCS, and CPT code assignment to ensure consistency and efficiency in the processing, data collection, and quality reporting associated with inpatient and outpatient claims.I. Major Responsibilities:1. Performs focused account and Coder quality reviews on inpatient and outpatient records to validate the DRG and current editions of ICD-CM, ICD-PCS, and CPT code assignment as well as missed secondary diagnoses or procedures which may impact the Severity of Illness (SOI) and Risk of Mortality (ROM). 2. Ensures compliance with all DRG, outpatient coding, and charging mandates as well as reporting requirements. 3. Validates the DRG and current editions of ICD-CM, ICD-PCS, and CPT code assignment to ensure consistency and efficiency in the processing, data collection, and quality reporting associated with inpatient and outpatient claims. 4. Demonstrates competency in the use of computer applications, DRG grouper software, as well as all coding and abstracting software currently used in HIM. 5. Runs daily reports to ensure all focused account reviews are worked to prevent the unnecessary holding of accounts prior to billing. Informs the Manager of Coding-HIM when backlog situations arise and necessary documents are either incorrect or not received in a timely manner. 6. Provides feedback on Coder quality reviews to the Manager of Coding-HIM, Supervisor of Inpatient Coding, Manager of Emergency Department (ED) Coding, and Manager of Radiology Coding based on the Coding Audit and Performance Management policy and procedure. 7. Creates and monitors Case Mix Index (CMI) reports and accuracy of the top 25 assigned DRGs to identify patterns, trends, and variations. 8. Creates and monitors outpatient reports and accuracy of top 25 assigned principle diagnoses to identify patterns, trends, and variations in the organization’s frequently assigned principle diagnoses, evaluation and management codes, modifiers, and CPT procedure changes. 9. Evaluates the root cause of any identified trends or possible problem areas. Reports variances to the Manager of Coding-HIM, Manager of ED Coding, and Manager of Radiology Coding. 10. Acts as a point person for Coding staff on questions or concerns related to ICD-CM (current edition), DRG, Evaluation and Management (E/M) code assignment as well as procedural coding and the retrospective query process. 11. Maintains direct and ongoing communications with Coding personnel to maximize overall effectiveness and efficiency of Coding operations. 12. Informs Manager(s) of any coding irregularities or trends contrary to policies / procedures and communicates with appropriate staff if necessary. 13. Assists the Manager of Coding-HIM in performance improvement initiatives and demonstrates the use of quality improvement in daily operations. 14. Assists the Manager of Coding-HIM in meeting department / unit goals and ensuring compliance with regulatory agencies such as Joint Commission, DPH, etc. 15. Works closely with the Retrospective CDIS Nurse and Clinical Documentation Improvement (CDI) Program team to continuously monitor the quality of clinical documentation to identify incomplete or inconsistent documentation in addition to any changes in DRG assignment and payment. 16. Monitors retrospective queries for appropriateness and may provide Coder feedback. Informs the Manager of Coding-HIM of any identified concerns. 17. Collaborates with the Manager of Coding-HIM as the primary department resource for the dissemination of DRG interpretations. 18. Collaborates with the Coding Educator to provide ongoing education to the Coding staff, Providers, and other clinicians to ensure appropriate assignment of current edition of ICD-CM, DRGs, E/M codes as well as modifiers and CPT procedure changes. 19. Collaborates with the Coding Educator to incorporate improvement efforts into coding in-services throughout the year. 20. Assists the Manager of Coding-HIM in preparing productivity reports and participates in the department’s total quality management studies. 21. Maintains DRG and coding accuracy rate of not less than 95% for optimal reimbursement as well as department productivity standards as outlined in department policies. 22. Attends required training classes and coding in-services each year to stay abreast of new regulations and coding guidelines. 23. Participates in improvement efforts and documentation training for medical and clinical staff as it relates to coding practices and guidelines. 24. Monitors Medicare and other DRG payer bulletins and manuals. Reviews current Office of Inspector General (OIG) work plans for DRG risk areas. 25. Keeps current with all coding updates and information related to correct coding.Standard Staffing Level Responsibilities:1. Complies with established departmental policies, procedures and objectives. 2. Attends variety of meetings, conferences, seminars as required or directed. 3. Demonstrates use of Quality Improvement in daily operations. 4. Complies with all health and safety regulations and requirements. 5. Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors. 6. Maintains, regular, reliable, and predictable attendance. 7. Performs other similar and related duties as required or directed.All responsibilities are essential job functions.II. Position Qualifications:License/Certification/Education: Required: 1. Bachelor’s degree in Business or Health Care Administration. 2. Certification as a Certified Coding Specialist (CCS).Preferred: 1. Certification as a Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT).Experience/Skills: Required: 1. Minimum of five (5) years of experience coding in a large, teaching, acute tertiary care setting with demonstrated coding expertise. 2. Extensive knowledge of current editions of DRGs, ICD-CM, ICD-PCS, and CPT coding systems. 3. Through knowledge of third-party payer requirements as well as federal and state guidelines and regulations pertaining to coding and billing practices. 4. General knowledge of hospital information systems as well as extensive knowledge of computer systems / applications used in HIM. 5. General knowledge of the retrospective CDI query process as well as guidelines for achieving a compliant query and associated compliance concerns. 6. Excellent customer service skills with the ability to communicate efficiently. 7. Exceptional organizational skills with attention to detail. 8. Ability to lead, organize, and support the work of less senior Coders is a primary function of this
#J-18808-Ljbffr

# **.***Exemption Status:**Exempt**Schedule Details:**Monday through Friday**Scheduled Hours:**7:00 a.m. - 3:30 p.m.**Shift:**1 - Day Shift, 8 Hours (United States of America)**Hours:**40**Cost Center:**99940 - 5458 Coding ServicesThis position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.# # **Everyone Is a Caregiver**At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.Performs focused account and quality reviews of coded records to support the ongoing performance management process. Validates the Diagnosis Related Group (DRG) and current editions of ICD-CM, ICD-PCS, and CPT code assignment to ensure consistency and efficiency in the processing, data collection, and quality reporting associated with inpatient and outpatient claims.I. Major Responsibilities:1. Performs focused account and Coder quality reviews on inpatient and outpatient records to validate the DRG and current editions of ICD-CM, ICD-PCS, and CPT code assignment as well as missed secondary diagnoses or procedures which may impact the Severity of Illness (SOI) and Risk of Mortality (ROM). 2. Ensures compliance with all DRG, outpatient coding, and charging mandates as well as reporting requirements. 3. Validates the DRG and current editions of ICD-CM, ICD-PCS, and CPT code assignment to ensure consistency and efficiency in the processing, data collection, and quality reporting associated with inpatient and outpatient claims. 4. Demonstrates competency in the use of computer applications, DRG grouper software, as well as all coding and abstracting software currently used in HIM. 5. Runs daily reports to ensure all focused account reviews are worked to prevent the unnecessary holding of accounts prior to billing. Informs the Manager of Coding-HIM when backlog situations arise and necessary documents are either incorrect or not received in a timely manner. 6. Provides feedback on Coder quality reviews to the Manager of Coding-HIM, Supervisor of Inpatient Coding, Manager of Emergency Department (ED) Coding, and Manager of Radiology Coding based on the Coding Audit and Performance Management policy and procedure. 7. Creates and monitors Case Mix Index (CMI) reports and accuracy of the top 25 assigned DRGs to identify patterns, trends, and variations. 8. Creates and monitors outpatient reports and accuracy of top 25 assigned principle diagnoses to identify patterns, trends, and variations in the organization’s frequently assigned principle diagnoses, evaluation and management codes, modifiers, and CPT procedure changes. 9. Evaluates the root cause of any identified trends or possible problem areas. Reports variances to the Manager of Coding-HIM, Manager of ED Coding, and Manager of Radiology Coding. 10. Acts as a point person for Coding staff on questions or concerns related to ICD-CM (current edition), DRG, Evaluation and Management (E/M) code assignment as well as procedural coding and the retrospective query process. 11. Maintains direct and ongoing communications with Coding personnel to maximize overall effectiveness and efficiency of Coding operations. 12. Informs Manager(s) of any coding irregularities or trends contrary to policies / procedures and communicates with appropriate staff if necessary. 13. Assists the Manager of Coding-HIM in performance improvement initiatives and demonstrates the use of quality improvement in daily operations. 14. Assists the Manager of Coding-HIM in meeting department / unit goals and ensuring compliance with regulatory agencies such as Joint Commission, DPH, etc. 15. Works closely with the Retrospective CDIS Nurse and Clinical Documentation Improvement (CDI) Program team to continuously monitor the quality of clinical documentation to identify incomplete or inconsistent documentation in addition to any changes in DRG assignment and payment. 16. Monitors retrospective queries for appropriateness and may provide Coder feedback. Informs the Manager of Coding-HIM of any identified concerns. 17. Collaborates with the Manager of Coding-HIM as the primary department resource for the dissemination of DRG interpretations. 18. Collaborates with the Coding Educator to provide ongoing education to the Coding staff, Providers, and other clinicians to ensure appropriate assignment of current edition of ICD-CM, DRGs, E/M codes as well as modifiers and CPT procedure changes. 19. Collaborates with the Coding Educator to incorporate improvement efforts into coding in-services throughout the year. 20. Assists the Manager of Coding-HIM in preparing productivity reports and participates in the department’s total quality management studies. 21. Maintains DRG and coding accuracy rate of not less than 95% for optimal reimbursement as well as department productivity standards as outlined in department policies. 22. Attends required training classes and coding in-services each year to stay abreast of new regulations and coding guidelines. 23. Participates in improvement efforts and documentation training for medical and clinical staff as it relates to coding practices and guidelines. 24. Monitors Medicare and other DRG payer bulletins and manuals. Reviews current Office of Inspector General (OIG) work plans for DRG risk areas. 25. Keeps current with all coding updates and information related to correct coding.Standard Staffing Level Responsibilities:1. Complies with established departmental policies, procedures and objectives. 2. Attends variety of meetings, conferences, seminars as required or directed. 3. Demonstrates use of Quality Improvement in daily operations. 4. Complies with all health and safety regulations and requirements. 5. Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors. 6. Maintains, regular, reliable, and predictable attendance. 7. Performs other similar and related duties as required or directed.All responsibilities are essential job functions.II. Position Qualifications:License/Certification/Education: Required: 1. Bachelor’s degree in Business or Health Care Administration. 2. Certification as a Certified Coding Specialist (CCS).Preferred: 1. Certification as a Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT).Experience/Skills: Required: 1. Minimum of five (5) years of experience coding in a large, teaching, acute tertiary care setting with demonstrated coding expertise. 2. Extensive knowledge of current editions of DRGs, ICD-CM, ICD-PCS, and CPT coding systems. 3. Through knowledge of third-party payer requirements as well as federal and state guidelines and regulations pertaining to coding and billing practices. 4. General knowledge of hospital information systems as well as extensive knowledge of computer systems / applications used in HIM. 5. General knowledge of the retrospective CDI query process as well as guidelines for achieving a compliant query and associated compliance concerns. 6. Excellent customer service skills with the ability to communicate efficiently. 7. Exceptional organizational skills with attention to detail. 8. Ability to lead, organize, and support the work of less senior Coders is a primary function of this
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# **.***Exemption Status:**Exempt**Schedule Details:**Monday through Friday**Scheduled Hours:**7:00 a.m. - 3:30 p.m.**Shift:**1 - Day Shift, 8 Hours (United States of America)**Hours:**40**Cost Center:**99940 - 5458 Coding ServicesThis position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.# # **Everyone Is a Caregiver**At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.Performs focused account and quality reviews of coded records to support the ongoing performance management process. Validates the Diagnosis Related Group (DRG) and current editions of ICD-CM, ICD-PCS, and CPT code assignment to ensure consistency and efficiency in the processing, data collection, and quality reporting associated with inpatient and outpatient claims.I. Major Responsibilities:1. Performs focused account and Coder quality reviews on inpatient and outpatient records to validate the DRG and current editions of ICD-CM, ICD-PCS, and CPT code assignment as well as missed secondary diagnoses or procedures which may impact the Severity of Illness (SOI) and Risk of Mortality (ROM). 2. Ensures compliance with all DRG, outpatient coding, and charging mandates as well as reporting requirements. 3. Validates the DRG and current editions of ICD-CM, ICD-PCS, and CPT code assignment to ensure consistency and efficiency in the processing, data collection, and quality reporting associated with inpatient and outpatient claims. 4. Demonstrates competency in the use of computer applications, DRG grouper software, as well as all coding and abstracting software currently used in HIM. 5. Runs daily reports to ensure all focused account reviews are worked to prevent the unnecessary holding of accounts prior to billing. Informs the Manager of Coding-HIM when backlog situations arise and necessary documents are either incorrect or not received in a timely manner. 6. Provides feedback on Coder quality reviews to the Manager of Coding-HIM, Supervisor of Inpatient Coding, Manager of Emergency Department (ED) Coding, and Manager of Radiology Coding based on the Coding Audit and Performance Management policy and procedure. 7. Creates and monitors Case Mix Index (CMI) reports and accuracy of the top 25 assigned DRGs to identify patterns, trends, and variations. 8. Creates and monitors outpatient reports and accuracy of top 25 assigned principle diagnoses to identify patterns, trends, and variations in the organization’s frequently assigned principle diagnoses, evaluation and management codes, modifiers, and CPT procedure changes. 9. Evaluates the root cause of any identified trends or possible problem areas. Reports variances to the Manager of Coding-HIM, Manager of ED Coding, and Manager of Radiology Coding. 10. Acts as a point person for Coding staff on questions or concerns related to ICD-CM (current edition), DRG, Evaluation and Management (E/M) code assignment as well as procedural coding and the retrospective query process. 11. Maintains direct and ongoing communications with Coding personnel to maximize overall effectiveness and efficiency of Coding operations. 12. Informs Manager(s) of any coding irregularities or trends contrary to policies / procedures and communicates with appropriate staff if necessary. 13. Assists the Manager of Coding-HIM in performance improvement initiatives and demonstrates the use of quality improvement in daily operations. 14. Assists the Manager of Coding-HIM in meeting department / unit goals and ensuring compliance with regulatory agencies such as Joint Commission, DPH, etc. 15. Works closely with the Retrospective CDIS Nurse and Clinical Documentation Improvement (CDI) Program team to continuously monitor the quality of clinical documentation to identify incomplete or inconsistent documentation in addition to any changes in DRG assignment and payment. 16. Monitors retrospective queries for appropriateness and may provide Coder feedback. Informs the Manager of Coding-HIM of any identified concerns. 17. Collaborates with the Manager of Coding-HIM as the primary department resource for the dissemination of DRG interpretations. 18. Collaborates with the Coding Educator to provide ongoing education to the Coding staff, Providers, and other clinicians to ensure appropriate assignment of current edition of ICD-CM, DRGs, E/M codes as well as modifiers and CPT procedure changes. 19. Collaborates with the Coding Educator to incorporate improvement efforts into coding in-services throughout the year. 20. Assists the Manager of Coding-HIM in preparing productivity reports and participates in the department’s total quality management studies. 21. Maintains DRG and coding accuracy rate of not less than 95% for optimal reimbursement as well as department productivity standards as outlined in department policies. 22. Attends required training classes and coding in-services each year to stay abreast of new regulations and coding guidelines. 23. Participates in improvement efforts and documentation training for medical and clinical staff as it relates to coding practices and guidelines. 24. Monitors Medicare and other DRG payer bulletins and manuals. Reviews current Office of Inspector General (OIG) work plans for DRG risk areas. 25. Keeps current with all coding updates and information related to correct coding.Standard Staffing Level Responsibilities:1. Complies with established departmental policies, procedures and objectives. 2. Attends variety of meetings, conferences, seminars as required or directed. 3. Demonstrates use of Quality Improvement in daily operations. 4. Complies with all health and safety regulations and requirements. 5. Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors. 6. Maintains, regular, reliable, and predictable attendance. 7. Performs other similar and related duties as required or directed.All responsibilities are essential job functions.II. Position Qualifications:License/Certification/Education: Required: 1. Bachelor’s degree in Business or Health Care Administration. 2. Certification as a Certified Coding Specialist (CCS).Preferred: 1. Certification as a Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT).Experience/Skills: Required: 1. Minimum of five (5) years of experience coding in a large, teaching, acute tertiary care setting with demonstrated coding expertise. 2. Extensive knowledge of current editions of DRGs, ICD-CM, ICD-PCS, and CPT coding systems. 3. Through knowledge of third-party payer requirements as well as federal and state guidelines and regulations pertaining to coding and billing practices. 4. General knowledge of hospital information systems as well as extensive knowledge of computer systems / applications used in HIM. 5. General knowledge of the retrospective CDI query process as well as guidelines for achieving a compliant query and associated compliance concerns. 6. Excellent customer service skills with the ability to communicate efficiently. 7. Exceptional organizational skills with attention to detail. 8. Ability to lead, organize, and support the work of less senior Coders is a primary function of this
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# **.***Exemption Status:**Exempt**Schedule Details:**Monday through Friday**Scheduled Hours:**7:00 a.m. - 3:30 p.m.**Shift:**1 - Day Shift, 8 Hours (United States of America)**Hours:**40**Cost Center:**99940 - 5458 Coding ServicesThis position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.# # **Everyone Is a Caregiver**At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.Performs focused account and quality reviews of coded records to support the ongoing performance management process. Validates the Diagnosis Related Group (DRG) and current editions of ICD-CM, ICD-PCS, and CPT code assignment to ensure consistency and efficiency in the processing, data collection, and quality reporting associated with inpatient and outpatient claims.I. Major Responsibilities:1. Performs focused account and Coder quality reviews on inpatient and outpatient records to validate the DRG and current editions of ICD-CM, ICD-PCS, and CPT code assignment as well as missed secondary diagnoses or procedures which may impact the Severity of Illness (SOI) and Risk of Mortality (ROM). 2. Ensures compliance with all DRG, outpatient coding, and charging mandates as well as reporting requirements. 3. Validates the DRG and current editions of ICD-CM, ICD-PCS, and CPT code assignment to ensure consistency and efficiency in the processing, data collection, and quality reporting associated with inpatient and outpatient claims. 4. Demonstrates competency in the use of computer applications, DRG grouper software, as well as all coding and abstracting software currently used in HIM. 5. Runs daily reports to ensure all focused account reviews are worked to prevent the unnecessary holding of accounts prior to billing. Informs the Manager of Coding-HIM when backlog situations arise and necessary documents are either incorrect or not received in a timely manner. 6. Provides feedback on Coder quality reviews to the Manager of Coding-HIM, Supervisor of Inpatient Coding, Manager of Emergency Department (ED) Coding, and Manager of Radiology Coding based on the Coding Audit and Performance Management policy and procedure. 7. Creates and monitors Case Mix Index (CMI) reports and accuracy of the top 25 assigned DRGs to identify patterns, trends, and variations. 8. Creates and monitors outpatient reports and accuracy of top 25 assigned principle diagnoses to identify patterns, trends, and variations in the organization’s frequently assigned principle diagnoses, evaluation and management codes, modifiers, and CPT procedure changes. 9. Evaluates the root cause of any identified trends or possible problem areas. Reports variances to the Manager of Coding-HIM, Manager of ED Coding, and Manager of Radiology Coding. 10. Acts as a point person for Coding staff on questions or concerns related to ICD-CM (current edition), DRG, Evaluation and Management (E/M) code assignment as well as procedural coding and the retrospective query process. 11. Maintains direct and ongoing communications with Coding personnel to maximize overall effectiveness and efficiency of Coding operations. 12. Informs Manager(s) of any coding irregularities or trends contrary to policies / procedures and communicates with appropriate staff if necessary. 13. Assists the Manager of Coding-HIM in performance improvement initiatives and demonstrates the use of quality improvement in daily operations. 14. Assists the Manager of Coding-HIM in meeting department / unit goals and ensuring compliance with regulatory agencies such as Joint Commission, DPH, etc. 15. Works closely with the Retrospective CDIS Nurse and Clinical Documentation Improvement (CDI) Program team to continuously monitor the quality of clinical documentation to identify incomplete or inconsistent documentation in addition to any changes in DRG assignment and payment. 16. Monitors retrospective queries for appropriateness and may provide Coder feedback. Informs the Manager of Coding-HIM of any identified concerns. 17. Collaborates with the Manager of Coding-HIM as the primary department resource for the dissemination of DRG interpretations. 18. Collaborates with the Coding Educator to provide ongoing education to the Coding staff, Providers, and other clinicians to ensure appropriate assignment of current edition of ICD-CM, DRGs, E/M codes as well as modifiers and CPT procedure changes. 19. Collaborates with the Coding Educator to incorporate improvement efforts into coding in-services throughout the year. 20. Assists the Manager of Coding-HIM in preparing productivity reports and participates in the department’s total quality management studies. 21. Maintains DRG and coding accuracy rate of not less than 95% for optimal reimbursement as well as department productivity standards as outlined in department policies. 22. Attends required training classes and coding in-services each year to stay abreast of new regulations and coding guidelines. 23. Participates in improvement efforts and documentation training for medical and clinical staff as it relates to coding practices and guidelines. 24. Monitors Medicare and other DRG payer bulletins and manuals. Reviews current Office of Inspector General (OIG) work plans for DRG risk areas. 25. Keeps current with all coding updates and information related to correct coding.Standard Staffing Level Responsibilities:1. Complies with established departmental policies, procedures and objectives. 2. Attends variety of meetings, conferences, seminars as required or directed. 3. Demonstrates use of Quality Improvement in daily operations. 4. Complies with all health and safety regulations and requirements. 5. Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors. 6. Maintains, regular, reliable, and predictable attendance. 7. Performs other similar and related duties as required or directed.All responsibilities are essential job functions.II. Position Qualifications:License/Certification/Education: Required: 1. Bachelor’s degree in Business or Health Care Administration. 2. Certification as a Certified Coding Specialist (CCS).Preferred: 1. Certification as a Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT).Experience/Skills: Required: 1. Minimum of five (5) years of experience coding in a large, teaching, acute tertiary care setting with demonstrated coding expertise. 2. Extensive knowledge of current editions of DRGs, ICD-CM, ICD-PCS, and CPT coding systems. 3. Through knowledge of third-party payer requirements as well as federal and state guidelines and regulations pertaining to coding and billing practices. 4. General knowledge of hospital information systems as well as extensive knowledge of computer systems / applications used in HIM. 5. General knowledge of the retrospective CDI query process as well as guidelines for achieving a compliant query and associated compliance concerns. 6. Excellent customer service skills with the ability to communicate efficiently. 7. Exceptional organizational skills with attention to detail. 8. Ability to lead, organize, and support the work of less senior Coders is a primary function of this
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