Documentation and Reimbursement Specialist

10 Nationwide Children's Hospital; Houston (TX); On-site; USD 65,000 - 90,000; Full time

Job summary

Nationwide Children's Hospital in Houston seeks an experienced physician billing specialist to research and respond to coding, documentation, compliance, and reimbursement inquiries. You will provide education sessions to physicians and staff and help resolve billing discrepancies with insurers.

The role requires strong clinical data interpretation, collaboration with providers, and updating billing software to ensure accurate claims processing.

Qualifications

• Five years of physician billing experience preferred.
• One year of education or teaching-related experience required.

Responsibilities

• Research and respond to inquiries about coding, documentation, compliance, and reimbursement.
• Provide compliance and documentation education sessions to physicians and staff.
• Clarify ambiguous clinical data and give feedback to improve documentation.
• Resolve billing discrepancies and issues with insurance providers.
• Collaborate with healthcare providers to gather necessary documentation for claims.
• Update billing software with relevant patient and insurance information.

Skills

Billing compliance

CPT-4 coding

Medical terminology

Communication skills

Team collaboration

Analytical skills

Privacy & confidentiality

Education

Bachelor’s degree preferred

CCS-P certification

CPC certification

Job description

Overview

Schedule: Monday‑Friday, 9:00am–5:00pm. Current in‑office requirement until cleared to work hybrid; on‑site two days per month after the probationary period. Schedule may change based on meetings.

Essential Functions

• Research and respond to inquiries about coding, documentation, compliance, and reimbursement.
• Provide compliance and documentation education sessions to physicians and staff.
• Clarify ambiguous clinical data and give feedback to improve documentation.
• Resolve billing discrepancies and issues with insurance providers.
• Collaborate with healthcare providers to gather necessary documentation for claims.
• Update billing software with relevant patient and insurance information.

Education Requirements

As required by listed licensure and/or certification requirement. Bachelor’s degree preferred.

Licensure Requirements

Not specified.

Certifications

• Certified Coding Specialist Physician‑Based (CCS‑P) – American Health Information Management Association (AHIMA)
• Certified Professional Coder (CPC) – American Academy of Professional Coders

Skills

• Proficiency with third‑party billing and documentation standards, particularly Evaluation and Management.
• Knowledge of medical terminology and proficiency with diagnosis and CPT‑4 coding.
• Excellent verbal and written communication skills.
• Ability to maintain and establish strong working relationships with physicians, support staff, and external parties.
• Capability to work both as a team player and independently.
• Strong analytical and quantitative analysis abilities.
• Strong problem‑solving, collaboration, and interpersonal skills.
• Ability to balance multiple priorities and deadlines.
• Proficiency with personal computers and related software.
• Attention to patient confidentiality.

Experience

Five years of experience in a related field (physician billing experience) preferred. One year of education or teaching‑related experience required.

Physical Requirements

• Occasionally: Driving motor vehicles as required; additional testing may be required.
• Lifting / Carrying: 0–10 lbs.
• Standing / Walking: Frequent.
• Decision‑Making, Interpreting Data, Problem‑Solving: Frequent.
• Continuous: Audible speech, computer skills, flexing/extending of neck, hand use (grasping, gripping, turning), hearing acuity, repetitive hand/arm use, visual acuity (near/far), sitting.
• Additional physical requirements performed but not listed above: not specified.

EEO Statement

EOE M/F/Disability/Vet.