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.
PRIMARY PURPOSE
Conducts audits of medical record coding to ensure compliance with established guidelines, provides results of audits, and assists with educational activities related to findings to promote adherence to state/federal laws and regulatory requirements.
MINIMUM SPECIFICATIONS
Education:
- Must be a graduate of a Health Information Management program or must have successfully completed an approved Coding educational program.
Experience
- Must have six (6) years of proven coding experience in an acute care setting.
Equivalent Education and/or Experience
- May have an equivalent combination of education and experience in lieu of specified requirements.
Certification/Registration/Licensure
- Because of the lag in SCCE, HCCA, NCRA, and AHIMA updating the status of certifications, current employees whose certification is granted through one of these associations are allowed up to seven (7) calendar days, after expiration, to provide proof of renewal. Although an additional seven (7) calendar days is allowed to provide proof of renewal, there cannot be a lapse in the certification's "active" status.
- Must possess one of the below certifications:
- Registered Health Information Administrator (RHIA)
- Registered Health Information Technician (RHIT)
- Certified Coding Specialist (CCS),
- Certified Professional Coder (CPC)
- Certified Coding Specialist - Physician (CCS-P)
- Certified Inpatient Coder (CIC)
- Certified Outpatient Coder (COC)
- Certified Professional Medical Auditor (CPMA)
Required Tests for Placement
- Must score a minimum of 85% on a pre-employment coding test.
Skills or Special Abilities
- Must be able to demonstrate time management, organizational, oral and written communication skills.
- Must be proficient and demonstrate and advanced knowledge in ICD-9-CM and CPT/HCPCS coding and abstracting and have an advanced clinical knowledge of medical terminology, disease process and pharmacology.
- Must be able to demonstrate knowledge of reimbursement (Medicare and Medicaid) principles and methodologies (MS-DRG and APC).
- Must have a working knowledge of the compliance guidelines related to coding and billing. - Must have strong skills in diplomacy, professionalism and trustworthiness.
- Must be able to demonstrate excellent computer skills, including word processing, spreadsheet and database management software proficiency.
Responsibilities
1. Conducts quality reviews on all coders using the "official coding guidelines" as published in AHA Coding Clinic and AMA CPT Assistant, and hospital policy, including specific payer guidelines, rules, regulations in analyzing questionable documentation to ensure the accuracy and completeness of clinical and financial information reported for billing of hospital services. Provides feedback to the coders on findings as needed. Provides reports of findings to the Coding Compliance Manager. The Outpatient area utilizes the CMS regulatory coding and billing guidelines, the National Correct Coding Initiative, the Local and National Coverage Determinations to resolve billing edits.
2. Analyzes medical record documentation to assure that coding and abstracting of data is in compliance with the ¿official coding guidelines¿ as published in the American Hospital Association¿s Coding Clinic for ICD-9-CM and the American Medical Associations CPT Assistant.
3. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the coding area. Provides input as requested to assist in the development of effective internal controls that promote adherence to applicable state/federal laws, and the program requirements of accreditation agencies and federal, state, and private health plans.
4. Stays abreast of the latest developments, advancements, and trends in medical records coding by attending educational programs, reading professional journals, actively participating in professional organizations, and maintaining certification. Integrates knowledge gained into current work practices.
5. Assists in ensuring that abstracted coded data and other elements are correct and appropriate. Assists in ensuring that data being submitted to state/federal and other regulatory agencies is correct and appropriate.
6. Maintains a positive working relationship with physicians, nurses, medical staff and hospital employees to ensure that all work-related encounters are productive.
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 for the department and Parkland.
8. This position is 100% Virtual. Virtual employees must also comply with all Parkland policies and procedures governing the use of Parkland information resources. Virtual employees must maintain all equipment lent by Parkland for performing the agreed upon job duties in good working condition. All employment responsibilities and conditions in applicable Parkland policies and procedures apply to employees while working virtually.
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.
