Coding Quality Assurance Specialist II

About Texas Children's Hospital

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. 

Think you’ve got what it takes? 

Job Duties & 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. 

Skills & Requirements 

• 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