Ambulatory Payment Classification

**Note: Office for this position is located at our Continuing Care Hospital**:
**701 S. Fry Rd. Katy, TX 77450**.**
- **Looking for Hospital Outpatient Medical Coders with 2 years of experience**:

- **Revenue Cycle experience is a plus**

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
- 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