Coding Specialist I

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. Must live in TX, AR, FL or WI PRIMARY PURPOSE The primary purpose of the Coding Specialist I is to code and verify charge data necessary to ensure correct coding, charging, abstracting, billing on Community Oriented Primary Care (COPC), Outpatient Clinics (OPC), Maternal and Fetal Medicine (MFM) and Women and Infants Specialty Health (WISH) encounters for professional billing. This position requires the coder to be highly proficient in the proper assignment/verification of evaluation and management (E/M), ICD-10-CM, CPT, HCPCS, HCC, HEDIS CAT II and modifier assignment. MINIMUM SPECIFICATIONS Education - High school diploma required - Must successfully completed an approved coding program - OR Must be a graduate of a Health Information Management program. Experience - Zero (0) years of experience required, however, one (1) year of related experience in a acute care setting or diverse clinical specialties preferred. - Physician office coding, charging and billing experience preferred Certification/Registration/Licensure - Must have a Certified Coding Associate (CCA) certification OR Must be certified through the American Health Information Management Association as one of the following: - Registered Health Information Management Technician (RHIT) - Registered Health Information Management Administrator (RHIA) - Certified Coding Specialist (CCS) - Certified Coding Specialist Physician Based (CCS-P) -OR- - Must be certified through the American Association of Procedural Coders (AAPC) as one of the following: - Certified Professional Coder (CPC) - Certified Outpatient Coder (COC) - Certified Professional Coder Apprentice (CPC-A)* - Certified Professional Coder-Hospital (CPC-H) - Certified Professional Coder -Hospital Apprentice (CPC-H-A)* *If hired with CPC-A or CPC-H-A certification, employee must have apprentice designation removed from their certification within two years to continue in Coder I classification. Skills or Special Abilities - Strong coding and charge review skills understanding the utilization of modifiers and other coding, charging and billing rules to include AMA and other state and federal organizations. - Strong knowledge of ICD-9/ICD-10-CM, CPT-4/HCPCS, HCC and HEDIS CAT II coding and abstracting, applicable coding edits and general knowledge of Local Coverage for professional billing. - Score a minimum of 70% on a pre-employment outpatient coding assessment. Contract coders with a proven coding accuracy rate of 95% at Parkland Health and Hospital System are exempt from this requirement. - Strong working knowledge of medical terminology, the human disease process, anatomy and physiology. - Ability to demonstrate an increased proficiency in CAC and coding encoder skills within three (3) months of employment. - Moderate MS Office suite skills and working knowledge of electronic health records, Computer Assisted Coder (CAC) and encoder software - Knowledge of Epic EHR and 3M 360 coding and abstracting software is preferred. Responsibilities 1. Codes and conducts charge quality review of all episodes of care for Community Oriented Primary Care (COPC), Outpatient Clinics (OPC), Maternal and Fetal Medicine (MFM) and Women and Infants Specialty Health (WISH) encounters according to coding and billing guidelines and hospital policy. 2. Assigns appropriate evaluation and management (E/M) level, ICD 10-CM, CPT, HCPCS, HCC and/or HEDIS CAT II code according to the Centers of Medicare & Medicaid Services (CMS), AHA, AMA and other state and federal requirements. 3. Achieve and maintain 95% accuracy on quality reviews and productivity standards. 4. Verify, edit and/or enter charges based on documentation or insurance requirements reporting any discrepancies in a timely manner. 5. Updates, as appropriate, patient database with classification codes to provide sufficient patient health information according to Parkland's standards. 6. Stays abreast of the latest developments, advancements, and trends in the field of health information management by attending seminars/workshops, reading professional journals, actively participating in professional organizations and integrates knowledge gained into current work practices. 7. Identifies ways to improve work processes and improve customer (internal as well as external) satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland. 8. Facilitates a positive working relationship with physicians, nurses, and medical staff and hospital employees to ensure that all work related encounters are productive. 9. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the Coding area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding. 10. Maintains CE hours and renew annual coding credentials. Job Accountabilities 1. 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 of the department and Parkland. 2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices. 3. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding 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.