Job Ref: 23245
Talent Area: Administrative/Clerical
Houston Methodist Specialty Physician Group
Houston, TX 77030
Area/Department: Med Billing
Employment Type: Regular
Job Type: Full-Time
Organization: Houston Methodist
Work Shift: DAY
Work Week: M - F
Houston Methodist Specialty Physician Group - As one of the nation’s leading hospitals and academic medical centers Houston Methodist has brought together some of the nation’s leading experts in multiple specialties to serve our patients. As part of Houston Methodist Specialty Physician Group (HMSPG), these specialists not only provide excellent clinical care, but are on the forefront of research, developing leading-edge technologies and treatments, and teaching the medical pioneers of tomorrow. This combination of clinical service, research and academics ensures patients have access to the latest in treatments and technologies while providing the best in comprehensive patient care. Established as a non-profit corporation and certified by the Texas State Board of Medical Examiners, HMSPG enables physicians to maintain autonomy with respect to their clinical practice while growing their practice within an academic environment.
Applies correct coding conventions to patient charge encounters in a clinical environment. Responsible for abstracting diagnosis and procedural services from physician¿s records, correcting charge review and claim edit-related coding errors and reviews coding-related denials for appeal.
System and department specific ICARE 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.
Communicates regularly with physicians and Physician Organization Central Business Office (PO CBO) staff on clarification to accurately code diagnosis and procedures
Matches charge documents to appropriate billing sheets, operative reports, and medical records to ensure correct codes are applied and all billable procedures are captured accurately, timely and completely
Investigate and appeal unpaid, denied and partially paid claims by third party payors
Using current coding conventions and guidelines, codes and abstracts medical records for reimbursement purposes from patient charts, physician documentation, and medical diagnostic and / or interventional reports
Reviews individual medical records to verify and substantiate diagnosis and procedures for charge review, claim edit(s) and/or denied claims and submits clinical appeal or corrected claim
Verifies accuracy of claim forms for correct diagnosis and procedure order, service dates, place of service, etc.
Monitors and reports identified trends affecting claim reimbursements as directed by department and PO CBO management
Ensures the timely accomplishment of all ICD-10 development and milestones
Demonstrates the components of the ICARE values statement
Follows all safety rules while on the job. Reports accidents promptly and corrects minor safety hazards
Ensure protection of private health and personal information, including credit card information. Adhere to all HIPAA and PCI compliance regulations
Code clinical visits, surgery charges and office procedures
Responds to or clarifies internal requests for medical information
Follows through, in a timely manner, on all action steps requested by supervisor
Participates in coding roundtables and in-services for continuous education
Cross trains and provides back up coverage of team members to ensure continuous coding and charge capture activities for PO departments
Demonstrates the components of The Houston Methodist Experience Service Standards and translates them into specific expectations of staff to anticipate and meet customer service needs
Remain current on all coding procedures and assignments to provide assistance for absence (vacation, etc.)
Participate in educational activities and attend monthly billing staff meetings
Accountable for ongoing professional growth and development to maintain coding certification
This position description is not intended to be all inclusive, and the employee will also perform other reasonably related business duties as assigned by the immediate supervisor and other management as required. The Houston Methodist Hospital reserves the right to revise or change job duties and responsibilities as the need arises.
High School Diploma required
College Degree preferred.
2-5 years billing, coding, and/or collections experience
CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED
Active certification from AAPC, AHIMA or approved Specialty Society Coding Certification
SPECIAL KNOWLEDGE, SKILLS AND ABILITIES REQUIRED
Requires effective communication skills
Requires effective time management skills
Requires ability to understand and implement protocols
Requires experience with computer database management
Requires Microsoft Office skills
Must be a self-motivated individual with the ability to think critically and work independently.
Strong communication (verbal and written), organizational, problem solving and team player skills
Ability to multi-task in a fast paced environment, prioritize projects and work independently
Demonstrate a high level of professionalism, customer service and interpersonal skills and operate under strict confidentiality due to the significant amount of PHI
Professional Office Environment
Houston Methodist is an Equal Opportunity Employer.
Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law.
VEVRAA Federal Contractor – priority referral Protected Veterans requested.