- High School diploma or equivalent is required.
- Three years of coding experience in a health care or managed care setting.
- Three years of experience working with CPT/HCPCS, ICD-10-CM/PCS, and DRG coding guidelines and practices.
- Claims processing experience is preferred.
- Experience at a managed care organization is preferred.
- Certified through the American Health Information Management Association (AHIMA) as one of the following: Certified Coding Specialist (CCS), Certified Coding Associate (CCA)
- OR Certified through American Association of Procedural Coders (AAPC) as one of the following: Certified Professional Coder (CPC), or Certified Professional Coder – Payer (CPC-P)
- Knowledge of CPT/HCPCS, ICD-10-CM/PCS, and DRG coding guidelines and practices.
- Knowledge of medical terminology and anatomy is preferred.
- Strong analytical skills and a high level of attention to detail.
- Excellent verbal and written communication skills.
- Strong organizational skills and the ability to manage multiple competing projects and deadlines.
- Proficiency with Microsoft Office Excel, Word, and Outlook is required.
- Demonstrated ability to collaborate effectively and work as part of a team in a fast-changing environment.
- Proven ability to learn new areas of responsibility and adapt to change.
- Ability to work independently.
- Strong knowledge of Texas State Medicaid Guides & Handbooks - TMHP Provider Manuals, Uniform Managed Care Contract (UMCC), Uniform Managed Care Manual (UMCM), etc. is preferred.
- Knowledge of benefits configuration is preferred.
- Provides coding expertise to and collaborates with various PCHP departments and vendors.
- Monitors AMA/CMS/DHHS publications to identify changes that impact PCHP clinical and claims processes and manage necessary changes through completion.
- Performs research to and provides answers to coding questions from PCHP stakeholders.
- Complies with all legal requirements regarding coding procedures and practices.
- Conducts audits and coding reviews to ensure accuracy within PCHP's systems.
- Triages and troubleshoots coding related claims issues.
- Partners with PCHP departments and vendors on the implementation of new programs and products.
- Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines related to coding and keeps certification up to date.
- Other duties as assigned.
- Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of PCHP.
- Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
- Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding.
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Coding Compliance Specialist
3 weeks ago
ClaimReturn LLC Dallas, United StatesJob Description · Job DescriptionOur Mission: · ClaimReturn is a Client-First environment where all that we do helps make us better as we help to make all we interact with better as well. · #DYK: up to 80% of medical claims contain errors, and all Americans pay the price. ClaimR ...
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Coding Specialist II Remote
1 week ago
Parkland Health and Hospital System Dallas, United StatesInterested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and ...
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Medical Coding QA Specialist
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Jorie AI Dallas, United StatesJob Description · Job DescriptionSalary: $ $32.00 · The Medical Coding QA Specialist (CPC Certified) is responsible for the quality assurance of our internal coding team and performs quality audits to ensure compliance with coding guidelines, as well as departmental policies and ...
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360 Service Code Specialist
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Christus Health Irving, United States· Summary: · *CHRISTUS Health System offers the CodingQuality Specialist I position as a remoteopportunity. Candidate must reside in the states of Texas,Louisiana, Arkansas, New Mexico, or Georgia to further beconsidered for this position.* · The Coding QualitySpecialist reports ...
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Christus Health Irving, United States· Summary: · The Coding Quality Specialist reports to the HIM CodingEducation Manager to perform internal departmental coding reviewsin support of the Coding Operations Department's business needs.This position contributes to coding education and training andfacilitates pre-bill ...
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Code Enforcement Specialist
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Christus Health Irving, United States· Summary: · The Coding Quality Specialist reports to the HIM Coding Education Manager to perform internal departmental coding reviews in support of the Coding Operations Department's business needs. This position contributes to coding education and training and facilitates pre- ...
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Coding Quality Specialist I
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Christus Health Irving, United StatesSummary: · *CHRISTUS Health System offers the · Coding Quality Specialist · I · position as a remote opportunity. Candidate must reside in the states of Texas, Louisiana, Arkansas, New Mexico, or Georgia to further be considered for this position.* · The Coding Quality Specialist ...
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Children's Health Dallas, United States Full timeJob Title & Specialty Area: Clinical Documentation Improvement Specialist · Department: Coding and CDI · Location: Dallas | Trinity Towers · Shift: Monday - Friday 8am -4:30pm · Job Type: Remote · Why Children's Health? · At Children's Health, our mission is to Make Life Better ...
Certified Coding Specialist - Dallas, United States - Parkland Health and Hospital System
Description
Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that's served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It's our passion.
Primary Purpose
Parkland Community Health Plan's (PCHP's) Certified Coding Specialist will serve as PCHP's coding expert and is responsible for collaborating with and advising various PCHP teams on coding related projects, processes, and issues. The Certified Coding Specialist will monitor AMA/CMS/DHHS publications to detect changes that affect PCHP clinical and claims processes and will provide support as PCHP adds new programs and products.
Minimum Specifications
Education
Experience
Certification/Registration/Licensure
Skills or Special Abilities
Responsibilities
Job Accountabilities
#LI-GC1
Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status. As part of our commitment to our patients and employees' wellness, Parkland Health is a tobacco and smoke-free campus.
Certified Coding Specialist professionals in Dallas
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Bhaskar Rayavaram
Sr. Technology Leader
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Satish Kumar
Pega Professional