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.

PATIENT AGE GROUP(S) AND POPULATION(S) SERVED
Refer to departmental "Scope of Service" and "Provision of Care" plans, as applicable, for description of primary age groups and populations served by this job for the respective HM entity.

HOUSTON METHODIST EXPERIENCE EXPECTATIONS

• Provide personalized care and service by consistently demonstrating our I CARE values:
  • INTEGRITY: We are honest and ethical in all we say and do.
  • COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
  • ACCOUNTABILITY: We hold ourselves accountable for all our actions.
  • RESPECT: We treat every individual as a person of worth, dignity, and value.
  • EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.

• Practices the Caring and Serving Model

• Delivers personalized service using HM Service Standards

• Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)

• Intentionally collaborates with other healthcare professionals involved in patients/customers or employees' experiential journeys to ensure strong communication, ease of access to information, and a seamless experience.

• Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job

• Displays cultural humility, diversity, equity and inclusion principles

• Actively supports the organization's vision, fulfills the mission and abides by the I CARE values

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 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

Houston Methodist Specialty Physician Group - 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.  As part of Houston Methodist Specialty Physician Group (HMSPG), these specialists not only provide excellent clinical care, but are on the forefront of research, developing leading-edge technologies and treatments, and teaching the medical pioneers of tomorrow.  This combination of clinical service, research and academics ensures patients have access to the latest in treatments and technologies while providing the best in comprehensive patient care.  Established as a non-profit corporation and certified by the Texas State Board of Medical Examiners, HMSPG enables physicians to maintain autonomy with respect to their clinical practice while growing their practice within an academic environment.