Coding Specialist II

Are you looking for a career that offers both purpose and the opportunity for growth? Parkland Community Health Plan (PCHP) is a proud member of the Parkland Health family.  PCHP is a Medicaid Managed Care Organization servicing Texas Medicaid and CHIP in the Dallas Service Area.  PCHP works to fulfill of our mission by empowering members to live healthier lives.  By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job—it’s a passion to serve and improve lives every day.

OUTPATIENT EXPERIENCE NEEDED

Remote Must live in TX, AR, FL or WI

Primary Purpose

The primary purpose of the Coding Specialist II is to code and verify charge data necessary to ensure correct coding, abstracting, and billing on emergency department (ED), same day surgery (SDS), outpatient clinic (OPC), observation (OBS), specialty clinics and / or inpatient OB / newborn encounters. This role is also responsible for charge review on clinic and hospital visits to ensure accurate professional charging and billing. This position requires the coder to be highly proficient in the proper assignment of ICD-10 CM, PCS, CPT, HCPCS, HCC, HEDIS CAT II, E / M and modifier codes. Demonstrates the ability to provide direction to coding staff as it relates to coding integrity, established coding guidelines and Parkland’s policies to ensure accuracy of recorded patient medical information and appropriate reimbursement for services rendered.

Education

High school diploma required.

Must have successfully completed an approved coding program.

OR must be a graduate of a Health Information Management program.

Must have strong knowledge of Anatomy and Physiology and possess strong application skills.

Experience

Must have two (2) years of coding experience in an acute care setting or diverse clinical specialties.

Physician office coding, charging, and billing experience preferred

Equivalent Education and / or Experience

May have an equivalent combination of education and / or experience in lieu of specific education and / or experience as stated above.

Certification / Registration / Licensure

Must be certified through the American Health Information Management Association (AHIMA) as one of the following :

Registered Health Information Management Technician (RHIT)

Registered Health Information Management Administrator (RHIA)

Certified Coding Specialist (CCS)

Certified Coding Specialist Physician Based (CCS-P)

OR Must be certified through the American Association of Procedural Coders (AAPC) as one of the following :

Certified Professional Coder (CPC)

Certified Professional Coder-Hospital (CPC-H)

Certified Outpatient Coder (COC)

Skills or Special Abilities

Advance coding and charge review skills understanding the utilization of modifiers and other coding, charging and billing rules to include AMA and other state and federal organizations.

Advanced knowledge of ICD-9 / ICD-10-CM / PCS, CPT-4 / HCPCS, HCC and HEDIS CAT II, E / M coding and abstracting, APC classification and reimbursement structures, applicable coding edits and general knowledge of Local Coverage for hospital and professional billing.

Score a minimum of 80% on a pre-employment coding test. Contract coders with a proven coding accuracy rate of 95% at Parkland Health and Hospital System are exempt from this requirement.

Must have knowledge of medical terminology, the human disease process, anatomy and physiology.

Demonstrate proficiency in coding and encoder skills.

Demonstrate knowledge of computer software applications including MS Office and Computer Assisted Coding (CAC).

Knowledge of Epic EHR and 3M 360 coding and abstracting software is preferred.

Responsibilities

1. Code, abstract and conduct charge quality review on all episodes of care on emergency department (ED), same day surgery (SDS), outpatient clinic (OPC), observation (OBS) and / or inpatient OB / newborn hospital and specialty clinic encounters according to coding conventions, guidelines, and hospital policy, analyzing questionable documentation to ensure to the accuracy of information and resolves identified issues.

2. Assigns appropriate diagnosis and procedures codes utilizing ICD 10-CM / PCS, CPT, HCPCS, HCC and HEDIS CAT II, E / M codes according to the Centers for Medicare & Medicaid Services (CMS) requirements for both professional and hospital billing. May assist in training and reviewing the work of other coders for accuracy and efficiency.

3. Achieve and maintain 95% accuracy on quality reviews and assigned productivity standards.

4. May verify, edit and / or enter charges based on documentation or payer / billing requirements reporting any discrepancies in a timely manner.

5. Updates, as appropriate, patient database with classification codes and resolves conflicts or inconsistencies to provide sufficient patient health information according to Parkland’s standards.

6. Stays abreast of the latest developments, advancements, and trends in the field of health information management by attending workshops, reading professional journals, actively participating in professional organizations, and integrates knowledge gained into current work practices.

7. 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 the department and Parkland.

8. Facilitate a positive working relationship with physicians, nurses, and medical staff and hospital employees to ensure that all work-related encounters are productive.

9. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the Coding area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.

10. Maintains CE hours and renew annual coding credentials.

Job Accountabilities

1. 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 the department and Parkland.

2. 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.

3. 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 federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.

Parkland Community Health Plan (PCHP) 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.