DRG Inpatient Coding Quality Assurance Specialist III (Remote) | Houston, TX

to government and regulatory agencies. Ascertains the accuracy of the physicians' E/M and procedure coding to their documentation and completes the auditing reporting tool and provides this feedback to the education team and/or provider. Incumbent may perform only certain of the following Responsibility depending on their work assignment.

Job Duties & Responsibilities: Assigns ICD-10-CM, ICD-10-PCS, and/or CPT codes. Reviews and interprets physician documentation to appropriately assign diagnosis and procedure codes. Communicates with and provides feedback to the education team and/or providers. Reviews patient charges to determine necessary coding to complete the account. Identifies

principle and secondary diagnoses and procedure codes from the electronic medical record. Utilizes the encoder or coding books to generate ICD-10-CM, ICD-10-PCS, and CPT codes for diagnosis and procedures.

Sequences diagnosis and procedures to generate appropriate billing. Queries physicians to obtain diagnosis if not clearly provided in records. Utilizes other available resources for assignment of codes as necessary (e. g. Epic, MIQS, Cardio IMS, and coding reference materials). Assists other coders in resolving coding problems. Provides ICD-10 and CPT, for physician research projects, and for quality reporting purposes. Completes abstracts for records as appropriate. Assists

in correction of problem accounts. Reviews charts for completeness.

Participates in education and maintains certification. Assists in auditing records. Maintains concurrent coding for inpatient records. Skills & Requirements Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees unless approved for a medical or religious exemption. Required H. S. Diploma or equivalent Required Licenses/Certifications (one of below): CCA - Certified Coding Associate by the American Academy of Professional Coders (AAPC) CCS - Cert-Cert Coding Specialist by the American Health Information Management Association (AHIMA) CCS-P - Cert-CCS-P Physician Based by the American Health Information Management Association (AHIMA) CIPC - Certified Inpatient Coder by the American Academy of Professional Coders (AAPC) COC - Certified Outpatient Coder by the American Academy of Professional Coders (AAPC) CPC - Cert-Cert Professional Coder by the by the American Academy of Professional Coders (AAPC) CRC - Cert Risk Adjustment Coder by the American Academy of Professional Coders (AAPC) RHIA - Cert-Reg Health Inform.

Admins by the American Health Information Management Association (AHIMA) RHIT - Cert-Reg Health Inform.

TECH by the American Health Information Management Association (AHIMA) Required 4 years coding experience with preferred experience using an encoder and experience using an electronic medical record Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals.

Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area. To join our community of 14,000+ dedicated team members, visit texaschildrenspeople. org for career opportunities. You can also learn more about our amazing culture at infinitepassion. org. Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, interactionual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.