Houston Methodist
Senior Coding Specialist - (Telecommute - Must Reside in TX)
Houston Methodist, Houston, Texas, United States, 77246
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.)
EXPERIENCE
Five years of professional coding experience
LICENSES AND CERTIFICATIONS Required
Must have one of the following: CCS - Certified Coding Specialist (AHIMA) CPC – Certified Professional Coder (AAPC)
SKILLS AND ABILITIES
Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through ongoing 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
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.
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.
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
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QUALIFICATIONS EDUCATION
High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)
EXPERIENCE
Five years of professional coding experience
LICENSES AND CERTIFICATIONS Required
Must have one of the following: CCS - Certified Coding Specialist (AHIMA) CPC – Certified Professional Coder (AAPC)
SKILLS AND ABILITIES
Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through ongoing 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
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.
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.
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
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