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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.

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

Company Profile:

With more than 40 locations throughout the Greater Houston area, Houston Methodist Primary Care Group brings quality, compassionate care to the entire family and to the communities where our patients work and live. As part of the Houston Methodist health system — one of the nation’s leading health systems — the Primary Care Group offers efficient access to world-class specialty care and hospital services from a network comprised of the nation’s leading hospitals and health care professionals.