Outpatient Coding & QA Trainer

Harris Health; Houston (TX); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Harris Health seeks an experienced outpatient coder to perform in-depth reviews of coded records and ensure accuracy for proper reimbursement. You will educate staff and act as an advisor on coding compliance within a large health system.

Responsibilities include reviewing ICD-9-CM and CPT-4 coding, ensuring documentation supports codes, and monitoring claim edits for timeliness and quality. Strong knowledge of AMA, CMS, HIPAA is required.

Qualifications

• CCS/CCS-P and/or CPC/CPC-H credential required
• RHIA/RHIT credential preferred
• 5+ years outpatient coding experience required
• 2+ year(s) outpatient auditing experience preferred
• 3M encoder interfaced with EPIC EMR billing system
• Knowledge of AMA, CMS, ICD-9-CM, AHIMA and AAPC guidelines

Responsibilities

• Review internally and externally coded outpatient records to determine completeness and accuracy of ICD-9-CM coding and CPT-4/HCPCS coding
• Ensure codes are supported by clinical documentation for appropriate reimbursement
• Provide ongoing education to coders, physicians, and staff; serve in an advisory role for coding compliance
• Monitor timeliness and appropriateness of claim edit responses and report findings

Skills

Medical coding

Education

CCS/CCS-P and CPC/CPC-H credentials

RHIA/RHIT preferred

Tools

EPIC

Job description

About Us

Harris Health is the public healthcare safety-net provider established in 1966 to serve the residents of Harris County, Texas. As an essential healthcare system, Harris Health champions better health for the entire community, with a focus on low-income uninsured and underinsured patients, through acute and primary care, wellness, disease management and population health services. Ben Taub Hospital (Level 1 Trauma Center) and Lyndon B. Johnson Hospital (Level 3 Trauma Center) anchor Harris Health's robust network of 39 clinics, health centers, specialty locations and virtual (telemedicine) technology. Harris Health is among an elite list of health systems in the U.S. achieving Magnet® nursing excellence designation for its hospitals, the prestigious National Committee for Quality Assurance designation for its patient-centered clinics and health centers and its strong partnership with nationally recognized physician faculty, residents and researchers from Baylor College of Medicine; McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); and The University of Texas MD Anderson Cancer Center.

At Harris Health, we prioritize the well-being of our most valuable asset—our people—ensuring a culture of compassion, collaboration and excellence in serving Harris County's most in need. With integrity and accountability at our core, we commit to ‘leading with love’, embodying our dedication to quality care, education, and a steadfast respect for every individual's contribution to our mission.

JOB SUMMARY

Responsible for performing in-depth reviews of both internally and externally coded outpatient medical records/accounts to determine the completeness and accuracy of ICD-9-CM diagnostic coding and sequencing, CPT-4 and HCPCS procedural coding assignment, and appropriate modifier appendage in order to ensure that assigned codes are supported by corresponding clinical documentation and appropriate reimbursement is gained. Determinations regarding the timeliness and appropriateness of claim edit responses will also by monitored, addressed, and reported. Responsible for providing ongoing education to coders, physicians, and other staff while also serving in an advisory role for coding and regulatory compliance.

Minimum Qualifications

• Education/Specialized Training/Licensure: CCS/CCS-P and/or CPC/CPC-H credential required
• RHIA/RHIT credential preferred
• Work Experience (Years and Area): 5+ years outpatient coding experience required
• 2+ year(s) outpatient auditing experience preferred
• Management Experience (Years and Area): None required
• Equipment Operated: 3M encoder interfaced with EPIC electronic medical record billing system

Special Requirements

• Communication Skills:
  • Above Average Verbal (Heavy Public Contact)
  • Exceptional Verbal (e.g., Public Speaking)
  • Bilingual Skills Required: No
• Writing /Composing (Correspondence/ Reports)
• Other Skills:
  • Analytical, Mathematics-Basic, Medical Terms, Statistical-Basic, P.C., MS Word-Basic, MS Excel-Basic
• Work Schedule: Weekends, Holidays, Flexible, Eligible for Telecommute
• Other Requirements:Detailed knowledge of coding conventions and rules established by the American Medical Association (AMA), the Center for Medicare and Medicaid Services (CMS), the ICD-9-CM Official Coding Guidelines, AHIMA, and AAPC for assignment of diagnostic and procedural codes

Detailed knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology

Detailed knowledge of classification systems, ICD-9-CM nomenclature, CPT-4, and HCPCS nomenclature, coding rules, guidelines, and proper sequencing

Knowledge of JCAHO, Privacy Act of 1974, and HIPAA standards

Knowledge of ethical coding principles and revenue cycle activities

Skill in interpreting and applying ethical coding standards, understanding federal and state laws and regulations, and following professional practice standards for health care organization coding compliance program activities