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.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.
This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.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
WORK EXPERIENCE
Two years of coding experience
One year of revenue cycle experience preferred
LICENSES AND CERTIFICATIONS - REQUIRED
CPC - Certified Professional Coder (AAPC) OR
COC - Certified Outpatient Coder (AAPC) OR
COCA - Certified Outpatient Coder Apprentice (AAPC) OR
CPCA - Certified Professional Coder Associate (AAPC) OR
CCS - Certified Coding Specialist (AHIMA) OR
An approved Specialty Society Coding Certification
KNOWLEDGE, 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
SUPPLEMENTAL REQUIREMENTSWORK ATTIRE
Uniform No
Scrubs No
Business professional Yes
Other (department approved) Yes
ON-CALLNote that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.
On Call No
TRAVELTravel specifications may vary by department
May require travel within the Houston Metropolitan area No
May require travel outside Houston Metropolitan area No
Company Profile:Houston Methodist is one of the nation’s leading health systems and academic medical centers. Houston Methodist consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the heart of the Texas Medical Center, and seven community hospitals throughout the greater Houston area. Houston Methodist also includes an academic institute, a comprehensive residency program, a global business division, numerous physician practices and several free-standing emergency rooms and outpatient facilities. Overall, Houston Methodist employs more than 27,000 employees and is supported by a wide variety of business functions that operate at the system level to help enable clinical departments to provide high quality patient care.Houston Methodist is an equal opportunity employer inclusive of women, minorities, disabled persons and veterans.Equal Employment OpportunityHouston Methodist is an Equal Opportunity Employer.Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law. VEVRAA Federal Contractor – priority referral Protected Veterans requested.Houston Methodist is an Equal Opportunity Employer.Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law. VEVRAA Federal Contractor – priority referral Protected Veterans requested.