Lead, Coding Specialist

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.

PRIMARY PURPOSE

The primary purpose of the Virtual Lead Coding Specialist is to improve internal and external quality audit scores for coders and the coding department by Conducting ad hoc coding quality reviews to proactively identify coder improvement opportunities, create and facilitate education and training action plans, and collaborate with Coding Integrity Quality and Compliance teams to reduce audit and denial risk to the organization from coding and billing. Demonstrates the ability to provide direction to coding staff as it relates to coding integrity, established coding guidelines and Parkland's policies to ensure accuracy of recorded patient medical information and appropriate reimbursement for services rendered.

MINIMUM SPECIFICATIONS

Education

• High school diploma required.
• Must have successfully completed an approved coding program;
• OR Must be a graduate of a Health Information Management program.

Experience

• Must have nine (9) years of coding experience in a combination of acute care hospital and clinic professional environment.

Equivalent Education and/or Experience

• May have an equivalent combination of education and/or experience in lieu of specific education and/or experience as stated above.

Certification/Registration/Licensure

• 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)

Required Tests for Placement

• Must score a minimum of 85% on a pre-employment coding test. Contract coders with a proven coding accuracy rate of 95% at Parkland Health and Hospital System are exempt from this requirement.

Skills or Special Abilities

• Must be able to demonstrate advanced knowledge of ICD-9/ICD-10-CM/PCS coding and abstracting, MS-DRG classification and reimbursement structures, applicable coding edits and general knowledge of Local Coverage.
• Must be able to demonstrate knowledge of reimbursement (Medicare and Medicaid) principles.
• Must have knowledge of medical terminology, the human disease process, anatomy, and physiology.
• Must be able to demonstrate good organizational and leadership skills.
• Must be able to effectively communicate, both orally and in writing.
• Must be able to demonstrate knowledge of computer software applications including MS Office and Computer Assisted Coding (CAC).

Responsibilities

1. Conducts ad hoc coding quality reviews to ensure coding quality of the department.

2. Identifies coder trend opportunities from internal and external audits and advise coding manager of identified trends/patterns and facilitates action plan for improvement.

3. Coaches other coders by training, educating and advising on coding and abstracting according to ICD-10-CM/PCS conventions and guidelines, responding to coding inquiries, reviewing and noting coded charts, providing feedback and monitoring chart corrections to ensure that noted changes have been made to facilitate coding consistency, accuracy, efficiency and appropriate billing and reimbursement.

4. Contributes with workflow, priorities for work completion, and communicating workflow issues to the supervisor. Identifies ways to improve work processes and improve customer satisfaction.

5. Assigns appropriate principle and secondary diagnosis and procedures codes for all episodes of care on inpatient encounters ensuring appropriate DRG assignment according to ICD-10-CM/PCS conventions, guidelines, and hospital policy.

6. Achieve and maintain 95% accuracy on quality reviews and meet assigned productivity standards.

7. Abstracts statistical data from the medical record and enter information according to Parkland's guidelines, policies, and procedures.

8. Demonstrates knowledge of billing and coding requirements for governmental guidelines and private insurance payers. May verify, edit and/or enter charges based on documentation or insurance requirements reporting any discrepancies in a timely manner.

9. Verifies, edits and/or enters charges based on documentation or insurance requirements reporting any discrepancies in a timely manner.

10. Collaborates with physicians and nurses by telephone or in writing to clarify or complete records by obtaining missing diagnoses, procedures, or information, resolving ambiguous coding episodes to ensure that missing information is corrected and resubmitted for payment.

11. Routine Screenings/Proof of Immunizations Exclusions: Virtual workforce employees as defined by Parkland's Virtual Work procedure, and as specified in their job descriptions, are not required to undergo routine screening for communicable diseases including TB, the flu vaccination, or the COVID-19 vaccination.

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.