Clinical Coding & Claims Resolution Analyst

South Texas Health System; Edinburg (TX); Remote; USD 70,000 - 90,000; Full time

Job summary

South Texas Health System seeks an experienced coding professional to serve as a key liaison across Texas facilities, focusing on outpatient coding edits, NCCI, and medical necessity. You will resolve complex coding issues in real time, supporting DNFB initiatives and audits while collaborating with HIM, Revenue Cycle, and clinical teams to ensure compliant, timely claim submissions.

This role demands advanced ICD-10-CM/CPT knowledge, strong decision-making, and the ability to interact with

Qualifications

• Associates degree or higher in Health Information Management (HIM) or business-related field; 6 years coding experience may substitute for degree.
• Coding certification is required or to be obtained within 12 months of employment.
• High School diploma, GED, or higher education required.
• Strong customer service skills and ability to interact with senior leadership.
• Advanced knowledge of ICD-10-CM, CPT, HCPCS, and OCE/APC/NCCI/LMRP guidelines.

Responsibilities

• Resolve complex coding and billing issues across multiple facilities.
• Perform real-time corrections for coding and claims to ensure timely submission.
• Support DNFB initiatives and audit reviews for outpatient accounts.
• Collaborate with HIM, Revenue Cycle, and clinical departments to maintain compliance and quality standards.

Skills

Customer service

Coding experience

Office software

ICD-10-CM / CPT knowledge

Medicare regulations

Communication

Education

Associates or higher in HIM or related field

Coding certification

High School diploma or GED

Tools

Microsoft Office

Data mining tools

Job description

South Texas Health System seeks an experienced coding professional to serve as a key liaison across Texas facilities, focusing on outpatient coding edits, NCCI, and medical necessity. You will resolve complex coding issues in real time, supporting DNFB initiatives and audits while collaborating with HIM, Revenue Cycle, and clinical teams to ensure compliant, timely claim submissions.

This role demands advanced ICD-10-CM/CPT knowledge, strong decision-making, and the ability to interact with