Coding Quality Specialist - Revenue Cycle (Finance)

What we do here changes the world. UTHealth Houston is Texas' resource for healthcare education, innovation, scientific discovery, and excellence in patient care. That's where you come in.

Once you join us you won't want to leave. It's because we reward our team for the excellent service they provide. Our total rewards package includes the benefits you'd expect from a top healthcare organization (benefits, insurance, etc.), plus:

• 100% paid medical premiums for our full-time employees
• Generous time off (holidays, preventative leave day, both vacation and sick time - all of which equates to around 37-38 days per year)
• The longer you stay, the more vacation you'll accrue!
• Longevity Pay (Monthly payments after two years of service)
• Build your future with our awesome retirement/pension plan!

We take care of our employees! As a world-renowned institution, our employees' wellbeing is important to us. We offer work/life services such as...

• Free financial and legal counseling
• Free mental health counseling services
• Gym membership discounts and access to wellness programs
• Other employee discounts including entertainment, car rentals, cell phones, etc.
• Resources for child and elder care
• Plus many more!

Position Summary:

RESTRICTED TO MMS/REVENUE CYCLE/CHARGE CAPTURE & CODING

The Coding Quality Specialist is responsible for utilizing official coding guidelines, payer and established departmental policies and procedures to conduct coding quality assurance reviews within the Charge Capture/Coding department under the direction of the Manager, Charge Capture & Coding and the Director, Charge Capture & Coding. The Coding Quality Specialist provides feedback using reports and other tools to coders and coding managers, and helps ensure that coders are meeting established coding quality metrics. Assists in identifying the need for coder education and development.

We are looking for a Coding Quality Specialist to join our team and ensure the highest standards of coding quality and compliance. In this role, you'll review and audit medical records, provide feedback to coding staff, and implement best practices to enhance coding accuracy and efficiency. Your expertise will be instrumental in maintaining compliance with regulatory requirements and optimizing our revenue cycle. If you're dedicated to excellence and have a strong background in medical coding, we invite you to bring your skills to our innovative and supportive team.

• Department: Revenue Cycle
• Status: Full-time
• Location: Remote (4- 6 weeks onsite for training @ 1851 Crosspoint Ave, 77054) meetings, additional training, etc.).
• Must live in Texas (TX) This is a Remote position, and you must reside in Texas
• Must be able to attend any required onsite meetings

**We DO NOT provide lodging or mileage reimbursement for training**

Position Key Accountabilities:

1. Performs on-going coding quality assessments in accordance with departmental procedures. Reviews a pre-determined sample of coded encounters and tracks individual coder QA results. Monitors accuracy of code assignment, sequencing, modifier assignments, accuracy of billing provider names, dates of service and other essential elements that the coder is responsible for validating during the normal coding process. Completes reports of QA findings and provides feedback to the coding staff and leadership in a constructive manner to initiate coaching and/or corrective action if satisfactory accuracy rates are not achieved. Ensures encounters being reviewed have correctly assigned ICD-10 CM diagnosis, CPT and/or HCPCS procedure codes. Confirms that all applicable UTHealth and Coding Guidelines are being followed.
2. Responsible for TES/IDX/EPIC Edit Resolution and Coding inquiries. Reviews charge sessions that require resolution via coding and claim system edits in IDX and EPIC. Resolves edits per coding guidelines and department procedures. Performs coding quality checks on charge sessions in the EPIC random audit WQ. Responds to internal and external coding inquires while meeting established turnaround times.
3. Serves as a subject matter expert on coding and assists in training and ongoing education of coders. Works collaboratively with coding leader on identifying education needs. Provides formal, and informal, education as required.
4. Performs other coding functions as appropriate. Ensures departmental tracking logs are kept current. Assists in denial resolution. Assists with coding backlogs as necessary. Adheres to established productivity standards and maintains tracking tools. Stays up-to-date with all federal, stated and departmental coding guidelines and procedures.
5. Performs other duties as assigned.

Certification/Skills:

Must have one of the following certifications:
Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Specialist-Physician-based (CCS-P), or Certified Professional Coder (CPC). Knowledge of ICD-10 CM and CPT coding conventions. Proficiency in Microsoft Office suite, the ability to abstract data and maintain a database required
Effective verbal and written communication between internal and external customers
Excellent time management skills. Ability to work collaboratively in a remote environment.

Minimum Education:

Associates of Science degree in health information management or another related field.

Minimum Experience:

Four years of experience in a Health Information Management (HIM) multi-specialty coding. Coding auditing or related quality assurance work. EPIC and Cerner EMR experience preferred. May substitute required experience with equivalent years of education beyond the minimum education requirement.

Physical Requirements:

Exerts up to 20 pounds of force occasionally and/or up to 10 pounds frequently and/or a negligible amount constantly to move objects.

Security Sensitive:

This job class may contain positions that are security sensitive and thereby subject to the provisions of Texas Education Code § 51.215

Residency Requirement:

Employees must permanently reside and work in the State of Texas.