Senior Coding Specialist - (Telecommute - Must Reside in TX)
- Job Ref:
- 62731
- Talent Area:
- HIM/Medical Records
- Job Shift:
- 1st - Day
- Job Type:
- Full-Time
- Posted Date:
- Oct. 16, 2024
At Houston Methodist, the Sr Coding Specialist position is responsible for applying correct coding conventions to patient charge encounters in a clinical environment. This position abstracts diagnosis and procedural services from the physician record and reviews and corrects charge review and claim edit related coding errors in the electronic health record. In addition, the Sr Coding Specialist position is responsible for reviewing, correcting and appealing coding related claim denials and mentoring and cross training Coding Specialists.
Requirements:
- Communicates regularly with physicians and Physician Organization Central Business Office (PO CBO) staff on clarification to accurately code diagnosis and procedures.
- Collaborates with management on coding and diagnosis issues to reduce claims denials by providing verbal and written communication.
- Assists with knowledge sharing, training Coding Specialists, and department cross training; provides support to other team members as advised by the manager and/or supervisor.
SERVICE ESSENTIAL FUNCTIONS
- Responds to or clarifies internal requests from all business partners for medical coding information in a timely manner.
- Participates in coding round tables and in-services for continuing education.
- Cross trains and provides back up coverage of team members to ensure continuous coding and charge capture activities for PO departments.
QUALITY/SAFETY ESSENTIAL FUNCTIONS
- Codes and abstracts medical records for reimbursement purposes from patient charts, physician documentation, and medical diagnostic and/or interventional reports using current coding conventions and guidelines and tools such as 3M encoder.
- Reviews individual medical records to verify and substantiate diagnosis and procedures for charge review, claim edit(s) and/or denied claims and submits clinical appeal or corrected claim.
- Assists with the creation and review of department specific coding workflows and expectations.
FINANCE ESSENTIAL FUNCTIONS
- Matches charge documents to charge review & claim edit sessions, billing sheets, operative reports, and medical records to ensure correct codes are applied and billable services are captured.
- Works charge review and claim edit sessions within two business days of posting to the assigned work queues.
- Investigates and appeals unpaid, denied and partially paid claims by third party payors.
GROWTH/INNOVATION ESSENTIAL FUNCTIONS
- Pursues ongoing professional growth and development and participation in team meetings.
- Provides on-going coding and documentation education to physicians and clinical staff.
- Attends, in person, quarterly coding and revenue integrity team meetings.
This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.
Qualifications:
- High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)
WORK EXPERIENCE
- Five years of professional coding experience
- CPC - Certified Professional Coder (AAPC) OR
- CCS - Certified Coding Specialist (AHIMA) OR
- An approved Specialty Society Coding Certification
KNOWLEDGE, SKILLS, AND ABILITIES
- Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
- Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
- Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
- Knowledge of ICD-9, ICD-10, and CPT codes
- Working knowledge of medical terminology, anatomy, and physiology
- Proficiency with Microsoft Office applications such as Word and Excel
- Must be a self-motivated individual with the ability to think critically and work independently
- Must have the ability to multi-task in a fast paced rapidly changing healthcare environment
- Demonstrates a high level of professionalism, customer service, and interpersonal skills and operates under strict confidentiality guidelines
- Strong training, leadership, and mentoring skills
SUPPLEMENTAL REQUIREMENTS
WORK ATTIRE
- Uniform No
- Scrubs No
- Business professional Yes
- Other (department approved) No
ON-CALL*
*Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.
- On Call* No
TRAVEL**
**Travel specifications may vary by department**
- May require travel within the Houston Metropolitan area Yes
- May require travel outside Houston Metropolitan area No
Company Profile:
Houston Methodist Specialty Physician Group is an integral part of Houston Methodist’s overall strategy to become one of the nation’s leading academic medical centers. Established as a nonprofit corporation certified by the Texas State Board of Medical Examiners, the Specialty Physician Group enables physicians to maintain autonomy with respect to clinical practice while growing their practice within an academic environment.
Houston Methodist is an Equal Opportunity Employer.
Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law. VEVRAA Federal Contractor – priority referral Protected Veterans requested.
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