Coding Specialist - Museum District - Hybrid

At Houston Methodist, the 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.

FLSA STATUS
Non-exempt

QUALIFICATIONS

EDUCATION

• High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)
• Completion of a Coding Certificate Program

EXPERIENCE

• None

LICENSES AND CERTIFICATIONS
Required

• Requires CCA or CCS-P from AHIMA, CPC or CPCA from AAPC, or an approved Specialty Society Coding Certification

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-10, CPT, and HCPCS coding conventions
• 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

ESSENTIAL FUNCTIONS

PEOPLE ESSENTIAL FUNCTIONS

• Communicates regularly with physicians and Physician Organization Central Business Office (PO CBO) staff on clarification to accurately code diagnosis and procedures.
• Communicates any issues or pertinent information to the supervisor in a timely manner that impact diagnosis or coding charges.
• 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 and resolves coding claim edits.

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.
• Completes charge reconciliation assignments within the expected timeframe(s).

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

• Remains current on coding guidelines and regulations of various payors and specialty practices as directed by the supervisor and/or manager.
• Suggests front end coding charge review edits to manage and reduce the volume of back-end coding related denials.
• Participates in educational activities and attends scheduled accounts receivable (AR) risk assessment meetings as needed.

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

QUALIFICATIONS

EDUCATION

• High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)
• Completion of a Coding Certificate Program

EXPERIENCE

• None

LICENSES AND CERTIFICATIONS
Required

• Requires CCA or CCS-P from AHIMA, CPC or CPCA from AAPC, or an approved Specialty Society Coding Certification