Coding Quality Assur Spec II

 
Position: Coding Quality Assur Spec II

Job ID: 167136

Location: US-TX-Houston

Department: HIM Coding-Professional

Talent Area: Clerical

Full/Part Time: Full time

Regular/Temporary: Regular

Shift: 8a - 5p

About Texas Children's Hospital

Since 1954, Texas Children’s has been leading the charge in patient care, education and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades such as being consistently ranked as the best children’s hospital in Texas, and among the top in the nation by U.S.News & World Report as well as recognition from Houston Business Journal as one of this city’s Best Places to Work for ten consecutive years.

Texas Children’s comprehensive health care network includes our primary hospital in the Texas Medical Center with expertise in over 40 pediatric subspecialties; the Jan and Dan Duncan Neurological Research Institute (NRI); the Feigin Center for pediatric research; Texas Children’s Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children’s Hospital West Campus, a community hospital in suburban West Houston; and Texas Children’s Hospital The Woodlands, the first hospital devoted to children’s care for communities north of Houston. We have also created the nation’s first HMO for children, established the largest pediatric primary care network in the country and a global health program that is channeling care to children and women all over the world. Texas Children’s Hospital is also academically affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation.

To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.

Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.



Summary:

We are searching for a Coding Quality Assurance Specialist II — someone who works well in a fast-paced setting. In this position, you will assign and audit the accuracy of the ICD-10-CM and CPT codes to ambulatory, emergency center, observation, and day surgery records for purposes of billing, research, and providing information to government and regulatory agencies. Ascertains the accuracy of the physicians' E/M and procedure coding to their documentation, completes the auditing reporting tool, and provides feedback to the education team and/or provider.

Responsibilities:

  • Assigns ICD-10-CM, ICD-10-PCS, and CPT codes. Reviews and interprets documentation for appropriate diagnosis and procedures. Communicates with and provides feedback to the education team and/or provider. Identifies principle and secondary diagnoses and procedure codes from the electronic medical and/or paper record. Utilizes the encoder or coding books to correctly assign all ICD-10-CM, ICD-10-PCS, and CPT codes for diagnosis and procedures. Sequences diagnosis and procedures to generate appropriate ICD-10-CM, CPT, PCS, and DRG codes for billing. Queries physicians to obtain clarification or missing elements in the record preventing correct coding. Utilizes other available resources for assignment of codes as necessary (e.g., Epic, MIQS, Cardio IMS, Logician, and coding reference materials). Assists other coders in resolving coding problems/questions. Provides ICD-10 and CPT, for physician research projects, and reporting purposes.  
  • Completes abstracts for records when appropriate. Checks discharge disposition and attending physician for correctness. Completes neonatal information regarding birth weight, gestational age, TPN, ECMO and number of ventilator days. Extracts data regarding blood types, number of units and special unit stays. Enter consultations, as necessary. Abstracts billable charges directly from operative reports and/or physician encounter forms in a timely manner to ensure complete charge capture. Processes spreadsheets including charge master e-bills.  
  • Identifies problem accounts. Identifies incorrect admit/discharge dates. Identifies incorrect patient type. Provides ICD-10 and CPT codes for Business Services and physician office requests regarding non-billed or non-reimbursed claims. Answers inquiries from outpatient clinics and ancillary departments for appropriate assignment of ICD-9-CM and CPT codes. Identifies and reports charts filed under the wrong MRN. Performs charge corrections when appropriate. Provides quality customer service when resolving coding disputes. Reviews coding denials to ensure coding is accurate per provider documentation.  
  • Corrects problem accounts. Reviews charts for completeness. Identifies and reports charts requiring operative reports. Identifies and reports charts with missing documents needed for coding and billing purposes.  
  • Participates in education and maintains certification. Participates in Coding Roundtable. Prepares questions and provides charts as examples so that questions can be resolved. Obtains required number for CEUs for current certification and completes required education.  
  • Assists in auditing records. Assists in auditing records. Participates in record reviews as necessary. Re-reviews charts for correctness of diagnosis and procedure codes. Identifies accounts opened in error, accounts needing admit/discharge dates, and billing discrepancies. Resolves coding and compliance issues to ensure physician documentation criteria follow State and Federal regulations and guidelines. Audits peer coding. Audits physician coding. Abstracts and audits all diagnosis, CPT, and PCS codes during abstraction.  
  • Maintains concurrent coding for inpatient records. Maintains concurrent coding for inpatient records. Assigns diagnosis and procedure codes for patients in-house. Assigns procedure codes for extended patient stays as requested by patient accounting for billing cycle purposes. 

Qualifications:

  • Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children’s unless approved for a medical or religious exemption. 
  • Required H.S. Diploma or GED 
  • Required Licenses/Certifications (one of below)
  • CCA - Certified Coding Associate by the American Health Information Management Association (AHIMA)  
  • CCS - Cert-Cert Coding Specialist by the American Health Information Management Association (AHIMA) 
  • CCS-P - Cert-CCS-P Physician Based by the American Health Information Management Association (AHIMA) 
  • CIPC - Certified Inpatient Coder by the American Academy of Professional Coders (AAPC) 
  • COC - Certified Outpatient Coder by the American Academy of Professional Coders (AAPC)  
  • CPC - Cert-Cert Professional Coder by the American Academy of Professional Coders (AAPC) 
  • CRC - Cert Risk Adjustment Coder by the American Academy of Professional Coders (AAPC) 
  • RHIA - Cert-Reg Health Inform. Admins by the American Health Information Management Association (AHIMA) 
  • RHIT - Cert-Reg Health Inform. TECH by the American Health Information Management Association (AHIMA) 
  • Required 2 years' experience in coding 


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