Ambulatory APC Optimization Specialist

Come lead with us at Corporate At Houston Methodist, the Ambulatory Payment Classification (APC) Coordinator position is responsible for reviewing and correcting all claims edits related to the APC grouper, National Correct Coding Initiative (NCCI), Correct Coding Initiative (CCI), etc. This position reviews Current Procedural Terminology Fourth Edition (CPT-4)/Healthcare Common Procedure Coding System (HCPCS) code errors and communicates with key operational staff/stakeholders to ensure proper coding, charging, and compliant claims.

FLSA STATUS

Exempt

QUALIFICATIONS

EDUCATION

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

EXPERIENCE

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

LICENSES AND CERTIFICATIONS

Required 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)

SKILLS AND ABILITIES

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

ESSENTIAL FUNCTIONS

PEOPLE ESSENTIAL FUNCTIONS

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.

SERVICE ESSENTIAL FUNCTIONS

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.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

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.

FINANCE ESSENTIAL FUNCTIONS

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.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

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.

SUPPLEMENTAL REQUIREMENTS

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

QUALIFICATIONS

EDUCATION

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

EXPERIENCE

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

LICENSES AND CERTIFICATIONS

Required 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) Houston Methodist is an Equal Opportunity Employer. #J-18808-Ljbffr Houston Methodist