Remote Utilization Review Rn Jobs in Worcester, MA

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Exemption Status:
Non-Exempt
Hiring Range:
$25.83 - $38.36
Please note that the final offer may vary within this range based on a candidate's experience, skills, qualifications, and internal equity considerations.
Schedule Details:
Monday through Friday
Scheduled Hours:
8AM to 4:30PM
Shift:
1 - Day Shift, 8 Hours (United States of America)
Hours:
40
Cost Center:
99940 - 5446 Professional Billing Coding
Union:
SHARE (State Healthcare and Research Employees)
This 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.
Responsible for interpreting medical record data in order to process physician and/or facility charges. Assigns appropriate ICD-CM (current edition), CPT codes and modifiers as appropriate. Coordinates and performs work of assigned Coding Specialists and monitors progress and work quality. Trains employees, provides employee performance data, and fosters process improvements.
Responsible for interpreting medical record data in order to process physician and/or facility charges. Assigns appropriate ICD-CM (current edition), CPT codes and modifiers as appropriate. Coordinates and performs work of assigned Coding Specialists and monitors progress and work quality. Trains employees, provides employee performance data, and fosters process improvements.
Major Responsibilities:

• Distributes and monitors the flow of work for coding staff. Provides training and technical assistance to employees within the assigned work area. Assists supervisor in ensuring that assigned employees are provided with appropriate resources, materials, and methods. Provides recommendations to manager or supervisor for the most efficient utilization of assigned personnel. Relays work instruction from the supervisor. Reviews coded records for coding quality assurance. Provides instruction and feedback to coding staff regarding proper coding assignment as necessary.
• Acts as a point person/department resource for special projects/programs and responds to coding related questions and issues.
• Assists in MD, Resident and Nursing documentation reviews, audits, and educational sessions as applicable.
• Performs analysis on medical record documentation to include review of tests/reports, and determines appropriate codes, as defined by coding guidelines and other recognized reference materials.
• Abstracts and enters all codes and required demographic information into the UMMHC computer system and/or onto encounter forms.

Position Qualifications:
License/Certification/Education:
Required:

• High School education, plus medical coding certification and training in medical terminology from an accredited program. Recognized programs include AHIMA, NHA, and AAPC.
• CPC certified and experience in IR coding.

Experience/Skills:
Required:

• Five years of medical abstraction and coding experience or related work experience.
• Knowledge of ICD-CM (current edition) and CPT HCPCS coding systems, 3rd party payer requirements and federal/state guidelines and regulations pertaining to coding and billing practices.
• The ability to lead, organize, and support the work of less senior Coding Specialists is a primary function of this position.
• Requires good interpersonal and communications skills and maintains a professional manner when working with team members, management and other staff members.
• Requires intermediate level computer skills with the ability to use standard office software applications, such as Microsoft Office Excel and Word.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
We're striving to make respect a part of everything we do at UMass Memorial Health - for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.
As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.
If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.