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.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.
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.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
WORK EXPERIENCE
None
LICENSES AND CERTIFICATIONS - REQUIRED
CPC - Certified Professional Coder (AAPC) OR
CCA - Certified Coding Associate (AHIMA) OR
CPCA - Certified Professional Coder Associate (AAPC) 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-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
SUPPLEMENTAL REQUIREMENTSWORK ATTIRE
Uniform No
Scrubs No
Business professional Yes
Other (department approved) No
ON-CALLNote that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.
On Call No
TRAVELTravel 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.
