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Sr. Coding Specialist

HMS – Boston, MA

HMS makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to healthcare—now and in the future. Using innovative technology and powerful data analytics, we help government and commercial payers reduce costs, increase quality, and achieve regulatory compliance. We also help consumers take a more active role in their own health. Each year, we save our clients billions of dollars while helping people live healthier lives. At HMS, you will develop new skills and build your career in a dynamic industry while making a difference in the lives of others.
We are seeking a talented individual for a Sr. Coding Specialist who is responsible for performing coding validation reviews of medical records and/or other documentation to determine correct coding as defined by review methodologies specific to the contract for which review services are being provided. This involves completing medical review forms, accurately documenting findings and providing policy/regulatory support for determination. Acts as a resource to Coding staff and assists with coaching and training on processes, procedures and systems.

Essential Responsibilities:

  • Reviews medical information to collect data, insure appropriate billing of data and follow up on questions or concerns raised by nurse and physician reviewers or health care providers. Applies knowledge of Medicare/Medicaid rules and regulations pertaining to appropriate billing and coding of Medicare or Medicaid accounts.
  • Provides coaching and training to Coding Specialist staff on processes, procedures and systems used within Coding services; works with management team to ensure staff is working efficiently and effectively; provides user support to team on contract specific software programs.
  • Provides IT with system/user requirements; performs user testing and sign-off/approval per IS protocol; identifies user enhancements and system functionality errors, assigns work completion due dates.
  • Offers quality improvement suggestions on project protocols and processes; facilitates quality improvement plan development and implementation as requested, both internally and with external customers.
  • Identifies and coordinates routine contract deliverables to include producing and performing quality assurance on existing client reports and contract logs and all other reports requested by internal and external customers.
  • Communicates with health care professionals as a liaison regarding contract specifications. Relates any questions or concerns that cannot be addressed to manager for follow up. Distributes contract-specific information as appropriate.
  • Assists with project data analysis, reporting, and feedback.
  • Shares ideas on clinical topics through identification of needs or concerns within the community as a result of interactions.

Non-Essential Responsibilities:

  • Performs other functions as assigned

Knowledge, Skills and Abilities:

  • Demonstrated proficiency in medical record analysis and ICD-9-CM and CPT coding methodology.
  • Advance knowledge of medical codes, coding conventions and rules.
  • Demonstrated experience in medical review, chart audits, and quality improvement processes.
  • Demonstrated experience with coding systems.
  • Working knowledge of HIPAA Privacy and Security Rules.
  • Ability to be careful and thorough about detail.
  • Ability to analyze information and use logic to address work-related issues and problems.
  • Ability to multi-task.
  • Ability to build relationships both internally and externally.
  • Ability to demonstrate customer service and public relations skills.
  • Ability to demonstrate team process and facilitation skills.

Work Conditions and Physical Demands:

  • Primarily sedentary work in a general office environment
  • Ability to communicate and exchange information
  • Ability to comprehend and interpret documents and data
  • Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.)
  • Requires manual dexterity to use computer, telephone and peripherals
  • May be required to work extended hours for special business needs
  • May be required to travel at least 10% of time based on business needs

Certifications: (Required/Desired)

  • RHIA, RHIT, RN, CCS, CPC, or other licensed/accredited health care professional specific to scope of contract

Minimum Education:

  • High School diploma required; Associates degree preferred

Minimum Related Work Experience:

  • 3+ years clinical medical record coding experience preferably in a hospital setting
  • 1+ years clinical medical record auditing/validation experience required

Nothing in this job description restricts managements right to assign or reassign duties and responsibilities to this job at any time.

Job Type: Full-time


  • Query Development: 2 years (Preferred)
  • Data Mining: 2 years (Preferred)


  • High school or equivalent (Required)


  • CPC (Required)

Benefits offered:

  • Paid time off
  • Parental leave
  • Health insurance
  • Dental insurance
  • Healthcare spending or reimbursement accounts such as HSAs or FSAs
  • Other types of insurance
  • Retirement benefits or accounts
  • Education assistance or tuition reimbursement
  • Child Care benefits
  • Gym memberships or discounts
  • Commuting/travel assistance
  • Employee discounts
  • Flexible schedules
  • Workplace perks such as food/coffee and flexible work schedules

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