Serves as a key liaison for Texas facilities between Atlantic CBO, Coding, Health Information Management (HIM), Revenue Cycle, and Ancillary departments.
This role resolves complex coding and claims issues by performing real-time corrections and collaborating across departments to ensure accurate and timely claim submission. The position focuses on Outpatient Code Editor (OCE/APC), National Corrective Coding Initiative (NCCI), and medical necessity edits, while supporting DNFB resolution, audit support, and corrective action for coding and claims issues across multiple facilities.
The analyst also assists with DNFB initiatives, follows up on holds and aging accounts, supports audit reviews of outpatient accounts, and monitors and maintains reports as needed.
The role requires advanced coding expertise, strong decision-making, and effective collaboration to ensure coding and claims discrepancies are resolved in a timely manner in support of compliance, regulatory, and quality standards.
Qualifications
- Excellent customer service skills
- Clinical, Health Information Management/Coding, or patient financial experience
- Advanced proficiency in Microsoft Office applications and other data mining software
- Ability to identify trends, recommend process improvements, and implement educational initiatives
- Advanced knowledge of ICD-10-CM, CPT, HCPCS, medical necessity guidelines, OCE/APC, NCCI, and Local Medical Review Policies (LMRP)
- Understanding of Medicare and Medical Assistance regulations as needed
- Strong decision-making abilities and the capability to resolve complex coding and billing issues across multiple facilities
- Excellent communication and collaboration skills with the ability to interact with senior leadership, clinical staff, and coding/billing teams
- Commitment to compliance with all policies, procedures, required training, and reporting requirements
Education and Licensure
- Associate degree or above in Health Information Management or a business-related field, or 6 years of coding experience in a healthcare setting in lieu of a degree
- Coding certification required, or obtained within 12 months of employment
- High school diploma, GED, or higher education required
Location
Texas, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
Yes
Posted
1 week ago