Position Purpose: The Coding Quality Coordinator II is a journey-level role responsible for complex reviews of clinical documentation on inpatient and outpatient medical records. The position validates the accuracy of diagnostic and procedural coding, payment methodology, and reimbursement amounts, develops written rationales for findings, and responds to providers in support of appeal resolution.
Key Responsibilities
- Perform complex reviews of physician clinical documentation on inpatient and outpatient medical records.
- Analyze coding accuracy, official coding guidelines, and code assignment.
- Determine correct payment methodology and reimbursement.
- Develop written rationales to communicate findings to hospitals, providers, medical directors, and peer review teams.
- Conduct coding re-reviews for cases based on coding convention and sequencing guidelines.
- Identify clinical questions and refer cases to the Medical Director when needed.
- Respond to providers regarding appeal resolution.
- Review updates to Coding Clinics, coding newsletters, and other professional resources.
- Participate in ongoing coding-related and clinical education.
- Identify patterns of possible fraud or abuse and refer them for further evaluation.
- Conduct periodic peer reviews.
Requirements & Qualifications
Requirements and Qualifications
- AA in Health Information Technology preferred.
- Two years of experience with Diagnosis Related Groups (DRG), ICD-9-CM, ICD-10-CM/PCS, CPT, and HCPCS coding.
- One or more of the following certifications may be required: RHIA, RHIT, CCS, CCA, or CPC.
- Must be authorized to work in the U.S. without current or future employment-based visa sponsorship.
Benefits & Perks
Benefits
- Competitive pay
- Health insurance
- 401(k) and stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible remote, hybrid, field, or office work schedules
- Additional incentives may be available
Location
Texas, US
Employment Type
Full-time
Experience Level
Intermediate Level
Salary Range
$56,200 - $101,000
Remote work allowed
Yes
Posted
1 month ago