Ambulatory Payment Classification Coordinator-Outpatient Coder - Full Time - 100% Remote (Must Live in FL, TN, GA, LA, WA State, or TX)

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.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.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

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

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 REQUIREMENTSWORK ATTIRE

Uniform No

Scrubs No

Business professional Yes

Other (department approved) Yes

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

On Call No

TRAVELTravel 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 is one of the nation’s leading health systems and academic medical centers. Houston Methodist 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 area. Houston Methodist 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, Houston Methodist employs more than 27,000 employees and is supported by a wide variety of business functions that operate at the system level to help enable clinical departments to provide high quality patient care.Houston Methodist is an equal opportunity employer inclusive of women, minorities, disabled persons and veterans.Equal Employment OpportunityHouston 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.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.