Coding Specialist - Community Health Choice - Quality Department
Harris Health System is the public healthcare safety-net provider established in 1966 to serve the residents of Harris County, Texas. As an essential healthcare system, Harris Health champions better health for the entire community, with a focus on low-income uninsured and underinsured patients, through acute and primary care, wellness, disease management and population health services. Ben Taub Hospital (Level 1 Trauma Center) and Lyndon B. Johnson Hospital (Level 3 Trauma Center) anchor Harris Health’s robust network of 39 clinics, health centers, specialty locations and virtual (telemedicine) technology. Harris Health is among an elite list of health systems in the U.S. achieving Magnet® nursing excellence designation for its hospitals, the prestigious National Committee for Quality Assurance designation for its patient-centered clinics and health centers and its strong partnership with nationally recognized physician faculty, residents and researchers from Baylor College of Medicine; McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); The University of Texas MD Anderson Cancer Center; and the Tilman J. Fertitta Family College of Medicine at the University of Houston.
Skills / Requirements
JOB SUMMARY: The Coding Specialist performs reviews of claim lines details to support the Risk Adjustment and HEDIS programs and work with Community's Risk Adjustment and HEDIS vendors. The coding specialist will coordinate with internal and external resources in determining the appropriateness of diagnosis and procedure codes found in administrative and medical claims; review data elements to support the submissions for Risk Adjustment and HEDIS; to review and validate accuracy of HCCs identified in suspecting and RADV audit medical records; and develop reports of findings and recommendations for the Risk Adjustment and HEDIS team.
1. Education/Specialized Training/Licensure: High School diploma or equivalent. Associate's or Bachelor's degree preferred
2. Work Experience (Years and Area): 3 years' experience in Healthcare coding in the medical industry. Clinical documentation improvement experience required. Certified Coder or Medical Billing and Coding certification required. Acute care and hospital outpatient coding environment experience and Risk adjustment coding methodology experience preferred.
3. Management Experience (Years and Area): N/A
4. Software Operated: Microsoft Office (Word, Excel, Outlook)
SPECIAL REQUIREMENTS: (Check Applicable Areas)
1. Communication Skills:
Exceptional Verbal (e.g., Public Speaking)
Writing /Composing: Correspondence / Reports
2. Other Skills: Medical Terminology, Research, MS Word, MS Excel
3. Advanced Education:
Advanced Training Specialty: AHIMA/AAPC Certified Coder, Medical Billing and Coding certification required.
Bachelor's Degree Major: Degree preferred
4. Work Schedule: Flexible, Overtime
5. Other Requirements:
Medical coding expertise (CPT, ICD9/10 CM/PCS, HCPCS)
Strong written and verbal communications skills.
Strong interpersonal skills
Solid Knowledge of Medicaid and Commercial coding practices.
RESPONSIBLE TO: Supervisor/Manager
EMPLOYEE SUPERVISED: None