Senior HIM & Coding Analyst — Outpatient Claims Expert

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

Job summary

South Texas Health System seeks a skilled outpatient coding and claims liaison to resolve complex issues across Texas facilities. You will work with HIM, Revenue Cycle, and clinical teams to ensure accurate submissions and regulatory compliance.

Advanced ICD-10-CM, CPT/HCPCS knowledge and OCE/APC experience are required, with DNFB and audit support responsibilities. Strong collaboration and communication are essential in this role.

Qualifications

• Excellent customer service skills required
• Clinical, Health Information Management/Coding, or Patient Financial experience
• Advanced knowledge of ICD-10-CM, CPT, HCPCS, medical necessity guidelines, and OCE/APC, NCCI, and LM RP
• Strong decision-making abilities and ability to resolve complex coding and billing issues across multiple facilities
• Understand Medicare & Medical assistance regulations as needed
• Excellent communication and collaboration skills, with senior leadership, clinical staff, and coding/billing teams
• Adherence to Compliance Program and Code of Conduct

Responsibilities

• Resolve complex coding and claims issues in real time
• Collaborate across departments to ensure accurate, timely claim submission
• Focus on OCE/APC, NCCI, and medical necessity edits
• Address DNFB resolution, audit support, and action for coding/claims issues
• Assist with DNFB initiatives and aging accounts
• Assist with audit reviews of OP accounts conducted by AI or outsourced
• Monitor and maintain required reports

Skills

Coding expertise

ICD-10-CM

CPT/HCPCS

NCCI

LMRP

Data mining

Microsoft Office

Communication

Cross-functional

Education

Associates Degree in HIM or related field

Coding certification

Tools

Data mining software

Job description

South Texas Health System seeks a skilled outpatient coding and claims liaison to resolve complex issues across Texas facilities. You will work with HIM, Revenue Cycle, and clinical teams to ensure accurate submissions and regulatory compliance.

Advanced ICD-10-CM, CPT/HCPCS knowledge and OCE/APC experience are required, with DNFB and audit support responsibilities. Strong collaboration and communication are essential in this role.