Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston.
This role ensures accurate coding and reimbursement of claims submitted to third-party payors. The position involves reviewing patient charts, validating CPT, ICD-10, and HCPCS codes, supporting the Accounts Receivable team with denials and appeals, and identifying trends to improve claim outcomes.
This position offers remote work for candidates based in the Houston/Pearland, Texas geographic area.
Primary responsibilities
- Work assigned coding-related system and web-based work files
- Analyze accounts promptly to prevent missed filing or appeal deadlines
- Adjudicate claims in accordance with coding guidelines and departmental policies
- Correct physician coding as needed and refile corrected claims
- Research denied claims using payer websites and reimbursement guidelines
- Meet production and quality standards
- Identify payer reimbursement patterns and trends and make recommendations to management
- Perform physician specialty rejection auditing and recommend charge rules, claim edits, and best practice alerts
- Serve as a coding resource for business office employees on denials, appeals, and account follow-up
- Analyze and resolve aged accounts and provide feedback for auditing and training purposes
- Maintain certification and stay current on payer guidelines, CPT, and ICD coding updates
- Attend seminars and conferences to maintain AAPC coder certification
- Perform other duties as assigned
Requirements & Qualifications
Required qualifications
- Associate degree in Business Administration or related field, or equivalent experience
- Certified Professional Coder (CPC), Certified Coding Specialist-Physician Based (CCS-P), or Certified Coding Associate (CCA)
- 3+ years of ICD-10, CPT, and HCPCS coding/abstracting experience
- 3+ years of healthcare billing and collections experience
- Working knowledge of commercial insurance and CMS guidelines
- Knowledge of commercial payor policies, NCCI edits, and EOBs
- Strong PC skills
- Familiarity with commercial payor websites and tools
- Excellent written and verbal communication skills
- Presentation skills
Preferred qualifications
- 5+ years of experience in health care billing and collection
- Knowledge of secondary or supplemental insurance claim filing (COB)
- Experience with Epic
- Ability to work independently, meet deadlines, and remain composed in a high-interruption environment
Benefits & Perks
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase plan
- 401(k) contribution
- Eligible benefits subject to requirements
Location
Texas, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
1 week ago