Job Description

What we do here changes the world. UTHealth Houston is Texas’ resource for healthcare education, innovation, scientific discovery, and excellence in patient care. That’s where you come in.

UTHealth Houston Revenue Cycle is hiring for a Coding Denial Specialistto join their team of professionals. The Coding Denial Specialist will be responsible for reviewing and resolving coding-related denials from A to Z, interpreting and applying payer guidelines, tracking and trending denial data to help prevent future denials and identify trends with specific payers, and more. The ideal candidate will have multi-specialty coding experience. A/R follow-up and surgery coding experience are both a plus!

Location:1851 Crosspoint Avenue, Houston, Texas 77054 for 2 weeks or less for training, then Virtual/Remote except in special circumstances (meetings, additional training, etc.). Must live in Texas (TX).

Once you join us you won't want to leave. It’s because we reward our team for the excellent service they provide. Our total rewards package includes the benefits you’d expect from a top healthcare organization (benefits, insurance, etc.), plus:  

100% paid medical premiums for our full-time employees  

Generous time off (holidays, preventative leave day, both vacation and sick time – all of which equates to around 37-38 days per year) 

The longer you stay, the more vacation you’ll accrue! 

Longevity Pay (Monthly payments after two years of service) 

Build your future with our awesome retirement/pension plan! 

We take care of our employees! As a world-renowned institution, our employees’ wellbeing is important to us. We offer work/life services such as... 

Free financial and legal counseling 

Free mental health counseling services 

Gym membership discounts and access to wellness programs 

Other employee discounts including entertainment, car rentals, cell phones, etc. 

Resources for child and elder care 

Plus many more! 

Position Summary:

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

Residency Requirement:

Employees must permanently reside and work in the State of Texas.

Job Tags

Similar Jobs