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.

　　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; also 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.

　　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

　　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.

　　Attends, in person, quarterly coding and revenue integrity team meetings.

　　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.)WORK EXPERIENCE

　　Five years of professional coding experienceLICENSES AND CERTIFICATIONS - REQUIRED

　　CPC - Certified Professional Coder (AAPC) or

　　CCS - Certified Coding Specialist (AHIMA) 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-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

　　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* NoTRAVEL**

　　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:

　　As one of the nation’s leading hospitals and academic medical centers, Houston Methodist has brought together some of the nation’s leading experts in multiple specialties to serve our patients. Houston Methodist Specialty Physician Group employs over 800 physicians at more than 150 locations across Houston. Our specialists are on the forefront of research, developing leading-edge technologies and treatments, and teaching the medical pioneers of tomorrow. The combination of clinical service, research and academics ensure patients have access to the latest treatments and technologies while providing the best comprehensive patient care.

　　Houston Methodist is an equal opportunity employer inclusive of women, minorities, disabled persons and veterans.

　　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.