Technical Technical Advisor – Ambulatory Surgery/Charging
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Under the general supervision of the Senior Coding Manager the Technical Advisor oversees, reviews and advised on the integrity of the ambulatory surgery coding/charging programs for the Mass General Brigham (MGB) Coding Department. The Technical Advisor advises on external/internal coding reviews and audits, new coding/billing regulations impacts, coding and billing interlinking billing issues, coding education and workflow training for outpatient coding, claim edits and denials related to ambulatory surgery coding/charging. Technical Advisor assists on the MGB Coding and Revenue Cycle-wide projects as needed. Technical Advisor assists on writing policies and procedures; coding system implementation projects; and coding education in their area of expertise. Will work very closely with multiple levels of Coding leadership, Technical Advisors, Data Quality Specialists and Coders to ensure an efficient and accurate coding program.
- Reviews, advises and resolves system-wide claim edits and denials related to ambulatory surgery coding/charging to ensure workflow adherence and coding compliance. Informs and advises on regulation change impacts, coding changes, and system issues in this area. Utilizes resources including, but not limited to the Coding Clinics published by the American Hospital Association (AHA), CPT Assistant, Office of Inspector General regulations (OIG), CMS regulatory changes, and payer groups.
- Collaborates closely with entity-based case management staff to review and validate inpatient only procedures.
- Collaborates with Case Management and the Central Billing Office (CBO) to review requests related to CPT reporting for Medicare A to B rebills and Benefits Exhaust accounts.
- Acts as a Subject Matter Expert (SME)/Peer Reviewer for escalated reviews of unlisted and inpatient only CPT codes. Provides education and feedback to the coding team.
- Advises and assists on coding related issues for external groups, e.g. public and third-party payors. Including review of cases to advise if it is a coding, clinical documentation, or other issue(s) to be addressed by other departments.
- Reviews assigned documents to be updated as needed. This may include MGB Coding policies and procedures, MGB Coding tip sheets, MGB Coding Edit/Denials Processing Tools, MGB Coding Compliance Plan, workflow documentation, claim edit resolution guidance among other documents.
- Oversees and monitors workqueue volumes to ensure appropriate coverage and optimization of Coding department productivity KPIs.
- Performs claim edits and denials coding analyses for ambulatory surgery/charging as needed, determines if there are any trends, and prepares reports for reviews utilizing data in quality data reports to support remediation efforts.
- Facilitates and works closely with Revenue Cycle Operations departments such as Revenue Integrity, the Central Business Office (CBO), and local Revenue Operations teams to identify and resolve claims editing issues, denials and rejections to optimize workflows throughout the revenue cycle.
- Subject Matter Expert (SME) to external local and enterprise departments such as Case Management, Revenue Integrity, Revenue Operations and CBO for CPT and ICD-10 appropriateness and accuracy.
- Closely monitors days to timely file limit (TFL): proactively escalates TFL claims to appropriate vendor coding team, responsible for the timely completion of TFL claims and responding to RCO Weekly TFL Report
