Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.
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.
We are searching for a Coding Quality Assurance Specialist III -- someone who works well in a fast-paced setting. In this position, you will Assign and audits 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, and completes the auditing reporting tool and provides this feedback to the education team and/or provider. Incumbent may perform only certain of the following responsibilities depending on their particular work assignment.
Job Duties & Responsibilities
Assigns ICD-10-CM, ICD-10-PCS, and/or CPT codes. Reviews and interprets physician documentation to appropriately assign diagnosis and procedure codes. Communicates with and provides feedback to the education team and/or providers.
Completes abstracts for records as appropriate. Checks discharge disposition and attending physician for correctness. Completes neonatal information regarding birth weight, gestational age, TPN, ECMO and number of ventilator days.
Assists in correction of problem accounts. Identifies incorrect admit/discharge dates. Identifies incorrect patient type. Reviews charts for completeness. Identifies and reports charts requiring operative reports. Identifies and reports charts with documentation.
Participates in education and maintains certification. Facilitates coding education sessions (webinars, audio conferences, seminars, lunch and learn, newsletters) by researching and presenting topics assigned by manager each month. Prepares questions and provides examples of issues that have been discovered.
Assists in auditing records. Participates in peer coding reviews as necessary. Re-reviews charts for correctness of diagnosis and procedure codes.
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.
H.S. Diploma or equivalent
Certifications (one of below):
o CCA - Certified Coding Associate by the American Academy of Professional Coders (AAPC) o CCS - Cert-Cert Coding Specialist by the American Health Information Management Association (AHIMA) o CCS-P - Cert-CCS-P Physician Based by the American Health Information Management Association (AHIMA) o CIPC - Certified Inpatient Coder by the American Academy of Professional Coders (AAPC) o COC - Certified Outpatient Coder by the American Academy of Professional Coders (AAPC) o CPC - Cert-Cert Professional Coder by the American Academy of Professional Coders (AAPC) o CRC - Cert Risk Adjustment Coder by the American Academy of Professional Coders (AAPC) o RHIA - Cert-Reg Health Inform. Admins by the American Health Information Management Association (AHIMA) o RHIT - Cert-Reg Health Inform. TECH by the American Health Information Management Association (AHIMA)
• Required 4 years coding experience, preferred experience using an encoder and using an electronic medical record
Same Posting Description for Internal and External Candidates
Thank you for your interest in applying for this job position.
Texas Children’s is excited to announce that we are transitioning to a new applicant tracking system. During this transition, from April 11-17, 2016 our application functions on our Careers website will be temporarily deactivated.
We sincerely apologize for this inconvenience. Visit us on Monday, April 18, 2016 to check out our new features and apply!