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UT Health Coding Denial Specialist in Texas Medical Center-Houston, Texas

Coding Denial Specialist

Texas Medical Center-Houston, Texas

Professional/Managerial

McGovern Medical School at UTHealth

Requisition #: 210002AQ

Position Summary:

RESTRICTED TO MMS/REVENUE CYCLE/CHARGE CAPTURE & CODING

The Coding Denial Specialist is responsible for resolving denied claims within the Charge Capture/Coding department under the direction of the Manager, Charge Capture & Coding and the Director, Charge Capture & Coding. The Denial Specialist collaborates with members of the Revenue Cycle Management (RCM) team including Clinical Documentation Improvement (CDI) to identify trends and develop rejection prevention strategies. This position is responsible for providing feedback using reports and data to coding managers. The Coding Denial Specialist applies official coding guidelines, payer policies and established departmental policies and procedures to resolve claim rejections ensuring that timely filing deadlines have not been exceeded.

Position Key Accountabilities:

  1. Performs timely and accurate review of coding related denials, appeal and submission, including tracking findings. Addresses denied claims and performs research to resolve coding related rejections. Reviews medical record and coded information to determine if coding needs to be changed or if an appeal is needed for resolution. Monitors and tracks denial trends to help identify education/feedback opportunities. Proactively monitors Revenue Cycle communications and payer websites for policy and guideline changes.

  2. Responsible for reviewing underpayments in Rev Builder and resolving Claim Edits. Reviews charge sessions that require resolution via claim system edits in IDX and EPIC. Resolves edits per coding guidelines and department procedures. Performs reviews to validate missed coding opportunities and participates in meeting to review findings and provide feedback to coding leadership for coding education opportunities.

  3. Performs other Coding functions as appropriate, including assisting with coding backlogs as necessary.

  4. Adheres to established productivity standards and maintains tracking tools. Stays up-to-date with all federal, state and departmental coding guidelines and procedures. Attends department meetings to discuss denial trends and prevention opportunities.

  5. Performs other duties as assigned.

Certification/Skills:

Must have one of the following certifications:

Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Specialist-Physician-based (CCS-P), or Certified Professional Coder (CPC). Knowledge of ICD-10 CM and CPT coding conventions. Proficiency in Microsoft Office suite, the ability to abstract data and maintain a database required

Effective verbal and written communication between internal and external customers

Excellent time management skills. Ability to work collaboratively in a remote environment.

Minimum Education:

High School Diploma or equivalent. Associates degree in Health Information Management or related healthcare field is preferred.

Minimum Experience:

3 years of experience in a Health Information Management (HIM) multi-specialty coding. Strong professional (pro-fee) coding experience in multi-specialty clinic, EPIC/IDX and Cerner EMR experience is preferred.

May substitute required experience with equivalent years of education beyond the minimum education requirement.

Physical Requirements:

Exerts up to 20 pounds of force occasionally and/or up to 10 pounds frequently and/or a negligible amount constantly to move objects.

Security Sensitive:

This job class may contain positions that are security sensitive and thereby subject to the provisions of Texas Education Code § 51.215

If you are looking for a great healthcare career in Houston, visithttp://go.uth.edu/careers!

University of Texas Health Science Center at Houston (UTHealth)

Established in 1972 by The University of Texas System Board of Regents, The University of Texas Health Science Center at Houston (UTHealth) is Houston’s Health University and Texas’ resource for health care education, innovation, scientific discovery and excellence in patient care. The most comprehensive academic health center in the UT System and the U.S. Gulf Coast region, UTHealth is home to schools of biomedical informatics, biomedical sciences, dentistry, nursing and public health and the John P. and Kathrine G. McGovern Medical School. UTHealth includes The University of Texas Harris County Psychiatric Center, as well as the growing clinical practices UT Physicians, UT Dentists and UT Health Services. The university’s primary teaching hospitals are Memorial Hermann-Texas Medical Center, Children’s Memorial Hermann Hospital and Harris Health Lyndon B. Johnson Hospital.

UTHealth Benefits

UTHealth offers a comprehensive and competitive benefits package. For more information on our benefits programs please refer to the UTHealth Office of Benefits Website.

https://www.uth.edu/benefits/benefits-summary.htm

Equal Employment Opportunity Statement

UTHealth is committed to providing equal opportunity in all employment-related activities without regard to race, color, religion, sex, sexual orientation, national origin, age, disability, genetic information, gender identity or expression, veteran status or any other basis prohibited by law or university policy. Reasonable accommodation, based on disability or religious observances, will be considered in accordance with applicable law and UTHealth policy. The University maintains affirmative action programs with respect to women, minorities, individuals with disabilities, and eligible veterans in accordance with applicable law.

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As you may already know, UTHealth recently decided to take an important and necessary step to protect members of our community against COVID-19 by making COVID-19 vaccinations mandatory for all employees, residents, fellows, contractors, and volunteers. Individuals subject to the vaccination requirement must be fully vaccinated on or by January 4th, 2022. Additionally, all members of our community—including students and visitors—are required to comply with our new COVID-19 Workplace Safety Protocol, which contains masking and physical distancing requirements that applies in certain settings depending on the individual’s vaccination status.

In addition, all UTHealth employees who are assigned to work at a location that is subject to the affiliated partner’s hospital, clinical offices, or agency are required to abide by UTHealth’s rules and regulations, as well as the affiliate’s rules and regulations, including COVID-19 vaccination requirements.

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