Ambulatory Payment Classification Coordinator

• High School diploma or equivalent education (examples include: GED verification of homeschool equivalency partial or full completion of post-secondary education etc.)
• Bachelors degree preferred

• Two years of coding experience
• One year of revenue cycle experience preferred

• Must have one of the following:RHIT - Certified Health Information Technician (AHIMA)RHIA - Registered Health Information Administrator (AHIMA)CCS - Certified Coding Specialist (AHIMA)CCA Certified Coding Associate (AHIMA)CCS-P Certified Coding Specialist Physician-Based (AHIMA)CPC Certified Professional Coder (AAPC)CPC-H Certified Professional Coder Hospital (AAPC)CPC-I Certified Professional Coder Instructor (AAPC)CPC-A Certified Professional Coder Associate (AAPC)CCC Certified Cardiology Coder (AAPC)COC - Certified Outpatient Coder (AAPC)

• 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

• 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.

• 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.

• 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.

• 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.

• 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.

WORK ATTIRE
• Uniform: No
• Scrubs: No
• Business professional: Yes
• Other (department approved): Yes

ON-CALL*
*Note that employees may be required to be on-call during emergencies (ie. Disaster Severe Weather Events etc) regardless of selection below.
• On Call* No

TRAVEL**
**Travel specifications may vary by department**
• May require travel within the Houston Metropolitan area No
• May require travel outside Houston Metropolitan area No

Work Shift:

Job Category:

Houston Methodist is an Equal Opportunity Employer.