Overview

*Looking for Hospital Outpatient Medical Coders with 2 years of experience

*Revenue Cycle experience is a plus

Note: Office for this position is located at our Continuing Care Hospital:

701 S. Fry Rd. Katy, TX 77450. (Hybrid)

At Houston Methodist, the Ambulatory Payment Classification (APC) Coordinator position is responsible for reviewing and correcting all claims edits related to the APC grouper, National Correct Coding Initiative (NCCI), Correct Coding Initiative (CCI), etc. This position reviews Current Procedural Terminology Fourth Edition (CPT-4)/Healthcare Common Procedure Coding System (HCPCS) code errors and communicates with key operational staff/stakeholders to ensure proper coding, charging, and compliant claims.

Houston Methodist Standard

PATIENT AGE GROUP(S) AND POPULATION(S) SERVEDRefer to departmental "Scope of Service" and "Provision of Care" plans, as applicable, for description of primary age groups and populations served by this job for the respective HM entity.

HOUSTON METHODIST EXPERIENCE EXPECTATIONS

• Provide personalized care and service by consistently demonstrating our I CARE values:
  • INTEGRITY: We are honest and ethical in all we say and do.
  • COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
  • ACCOUNTABILITY: We hold ourselves accountable for all our actions.
  • RESPECT: We treat every individual as a person of worth, dignity, and value.
  • EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.

• Practices the Caring and Serving Model

• Delivers personalized service using HM Service Standards

• Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)

• Intentionally collaborates with other healthcare professionals involved in patients/customers or employees' experiential journeys to ensure strong communication, ease of access to information, and a seamless experience.

• Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job

• Displays cultural humility, diversity, equity and inclusion principles

• Actively supports the organization's vision, fulfills the mission and abides by the I CARE values

Responsibilities

PEOPLE ESSENTIAL FUNCTIONS

• Promotes a positive work environment and contributes to a dynamic team focused work unit that actively helps one another to achieve optimal department and organizational results.

• Collaborates with key stakeholders to address discrepancies with charges and medical records documentation.

• Addresses billing and coding edit issues that require specialized analyses; triages issues to Charge Description Master (CDM) team, medical records coding, or other revenue cycle partners as necessary.

SERVICE ESSENTIAL FUNCTIONS

• Reviews charges and medical records to ensure that claims are billed compliantly and are supported by medical record documentation. Communicates to management about barriers to compliant and accurate billing including medical record issues, department charging practices, etc.

• Recommends changes as needed to the Charge Description Master.

• Responds to referrals and customers with resolutions within the expected time frame.

• Trains department and revenue cycle staff as needed on regulatory items related to compliant coding on the claim.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

• Meets or exceeds stated departmental standards for Key Performance Indicators (KPI) (e.g., inventory management, productivity, quality reviews, etc.).

• Follows established coding rules and guidelines based on accurate documentation in the medical record when reviewing claims.

• Incorporates federal and state regulations, payor medical policies, case specific medical documentation, and claims information into claims review for timely and compliant billing.

FINANCE ESSENTIAL FUNCTIONS

• Analyzes data from various sources (medical records, claims data, payor medical policies, etc.), determines the causes for coding related edits or denials and partners with management to ensure timely billing and denial prevention.

• Analyzes APC/claim edits/coding denials to identify new trends, opportunities, and educational feedback as needed.

• Follows levels of authority for posting adjustments, refunds, and contractual allowances.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

• Actively engages in personal assessment and expands learning beyond baseline competencies with a focus on continual development (i.e., participates in training opportunities, focal point review activity, etc.). Applies new learning.

• Stays current on all federal and state regulations related to NCCI/CCI/APC and related edits.

This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.

Qualifications

EDUCATION

• High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)

• Bachelor's degree preferred

WORK EXPERIENCE

• Two years of coding experience

• One year of revenue cycle experience preferred

License/Certification

LICENSES AND CERTIFICATIONS - REQUIRED

• CPC - Certified Professional Coder (AAPC) OR
• COC - Certified Outpatient Coder (AAPC) OR
• COCA - Certified Outpatient Coder Apprentice (AAPC) OR
• CPCA - Certified Professional Coder Associate (AAPC) OR
• CCS - Certified Coding Specialist (AHIMA) OR
• An approved Specialty Society Coding Certification

KSA/ Supplemental Data

KNOWLEDGE, SKILLS, AND ABILITIES

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations

• Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security

• Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles

• Knowledge of patient account charge processes and a comprehensive understanding of Medicare coding rules and regulations

• Ability to follow-through and handle multiple tasks simultaneously

• Ability to work independently and interdependently with other business office staff

• Sharp analytical abilities in order to ensure proper coding and charging of related accounts

• Proficient computer skills and ability to learn and navigate multiple software programs

• Expert knowledge of the various state and federal insurance programs

• Ability to partner with various hospital departmental colleagues

• Knowledge of International Classification of Diseases (ICD) coding (procedure and diagnoses), CPT and HCPCS

• Knowledge of correct charging practices for non-Medicare carriers

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

• Uniform No
• Scrubs No
• Business professional Yes
• Other (department approved) Yes

ON-CALL**Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.

• On Call* No

TRAVEL****Travel specifications may vary by department**

• May require travel within the Houston Metropolitan area No
• May require travel outside Houston Metropolitan area No

Company Profile

Houston Methodist (HM) is one of the nation’s leading health systems and academic medical centers. HM consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the heart of the Texas Medical Center, and seven community hospitals throughout the greater Houston metropolitan area. HM also includes an academic institute, a comprehensive residency program, a global business division, numerous physician practices and several free-standing emergency rooms and outpatient facilities. Overall, HM employs over 25,000 employees. Houston Methodist is supported by a wide variety of business functions that operate at the system level to help enable clinical departments to provide the best patient care and service in a spiritual environment.

In 2019 Houston Methodist and its physicians treat more than 6,333 international patients from more than 76 countries. Houston Methodist Global Health Care Services’ consulting and education divisions also provide advisory services and training and development to health care organizations around the world.