Medical Billing and Coding

• Apply correct coding conventions to patient charge encounters in a clinical environment
• Abstract diagnosis and procedural services from physician records
• Review and correct charge review and claim edit-related coding errors in the electronic health record
• Review, correct, and appeal coding-related claim denials
• Mentor and cross-train Coding Specialists
• Communicate with physicians and Physician Organization Central Business Office staff to clarify diagnosis and procedures
• Collaborate with management to reduce claim denials
• Respond to internal requests for medical coding information
• Participate in coding round tables and in-services
• Provide backup coverage and cross-training for team members
• Code and abstract medical records for reimbursement using current coding conventions, guidelines, and tools such as 3M encoder
• Verify and substantiate diagnoses and procedures for charge review, claim edits, and denied claims
• Submit clinical appeals or corrected claims
• Create and review department-specific coding workflows
• Match charge documents, billing sheets, operative reports, and medical records to ensure accurate coding and capture billable services
• Complete charge review and claim edit sessions within two business days
• Investigate and appeal unpaid, denied, and partially paid third-party claims
• Provide ongoing coding and documentation education to physicians and clinical staff

Senior Coding Specialist

• Conduct high-volume chart reviews to identify coding gaps, trends, and opportunities for improved provider accuracy
• Translate chart-review findings into actionable insights
• Create and deliver education to providers and practice leaders
• Navigate complex conversations regarding coding and documentation
• Track and report key performance metrics, including HCC recapture rates, AWVs, and other KPIs
• Review provider documentation and medical records to verify Medicare Advantage, Affordable Care Act (ACO), and Commercial risk-adjustment requirements
• Deliver individual and group provider education for managed IPAs
• Review medical records retroactively and prospectively to identify, assess, monitor, and document claims and encounter coding information related to HCCs
• Perform code abstraction and coding quality audits to ensure accurate ICD-10-CM coding and clinical-documentation support
• Interact with physicians regarding coding, billing, documentation policies, procedures, and ambiguous documentation
• Prepare and perform auditing analysis and provide feedback on noncompliance
• Maintain knowledge of coding regulations, compliance guidelines, ICD-10 and HCC updates, and payer requirements
• Recommend process improvements, root-cause analysis, and barrier resolution for Risk Adjustment initiatives
• Train, mentor, and support new employees
• Provide peer-to-peer guidance and support coder training and orientation
• Assist with or lead projects and higher work volumes than Risk Adjustment Coding Specialist I
• Travel to provider offices twice weekly in the Houston area

Medical Billing and Coding jobs in Texas

Senior Coding Specialist

Risk Adjustment Coding Specialist II