Job Ref:

41630

Talent Area:

Administrative

Job Shift:

1st - Day

Job Type:

Full-Time

Posted Date:

April 18, 2023

JOB SUMMARY

At Houston Methodist, the Senior Coding Specialist position is responsible for applying correct coding conventions to patient charge encounters in a clinical environment. The Senior Coding Specialist 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 Senior Coding Specialist is responsible for reviewing, correcting and appealing coding related claim denials and mentoring and cross training Coding Specialists.

PRIMARY JOB RESPONSIBILITIES

Job responsibilities labeled EF capture those duties that are essential functions of the job.

PEOPLE - 20%

• Communicates regularly with physicians and Physician Organization Central Business Office (PO CBO) staff on clarification to accurately code diagnosis and procedures. (EF)
• Collaborates with management on coding and diagnosis issues to reduce claims denials by providing verbal and written communication. (EF)
• Assists with knowledge sharing, training Coding Specialists, and department cross training; also provides support to other team members as advised by the manager and/or supervisor. (EF)

SERVICE - 20%

• Responds to or clarifies internal requests from all business partners for medical coding information in a timely manner. (EF)
• 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. (EF)

QUALITY/SAFETY - 20%

• 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. (EF)
• 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. (EF)
• Assists with the creation and review of department specific coding workflows and expectations.

FINANCE - 20%

• 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. (EF)
• Works charge review and claim edit sessions within two business days of posting to the assigned work queues. (EF)
• Investigates and appeals unpaid, denied and partially paid claims by third party payors. (EF)

GROWTH/INNOVATION - 20%

• Pursues ongoing professional growth and development and participation in team meetings. (EF)
• Provides on-going coding and documentation education to physicians and clinical staff.
• Attends, in person, quarterly coding and revenue integrity team meetings. (EF)

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 REQUIREMENTS

o High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)

EXPERIENCE REQUIREMENTS

o Five years of professional coding experience

CERTIFICATIONS, LICENSES AND REGISTRATIONS REQUIRED
o Certified Professional Coder (CPC) through the American Academy of Professional Coders (AAPC) or Certified Coding Specialist (CCS) through the American Health Information Management Association (AHIMA); or an approved Specialty Society Coding Certification

KNOWLEDGE, SKILLS AND ABILITIES REQUIRED

o Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations

o 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

o 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

o Knowledge of ICD-9, ICD-10, and CPT codes

o Working knowledge of medical terminology, anatomy, and physiology

o Proficiency with Microsoft Office applications such as Word and Excel

o Must be a self-motivated individual with the ability to think critically and work independently

o Must have the ability to multi-task in a fast paced rapidly changing healthcare environment

o Demonstrates a high level of professionalism, customer service, and interpersonal skills and operates under strict confidentiality guidelines

o Strong training, leadership, and mentoring skills

SUPPLEMENTAL REQUIREMENTS

Work Attire Yes/No

Uniform No

Scrubs No

Business professional Yes

Other (dept approved) No

On-Call* No (for Non-Exempt or Exempt jobs)

Travel**

May require travel within Yes

Houston Metropolitan area

May require travel outside No

of Houston Metropolitan area

**Travel specifications may vary by department.

Please note any other special considerations to this job: __________________________