Certified Coding Specialist - PCHP

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion.

Primary Purpose

Parkland Community Health Plan’s (PCHP’s) Certified Coding Specialist will serve as PCHP’s coding expert and is responsible for collaborating with and advising various PCHP teams on coding related projects, processes, and issues. The Certified Coding Specialist will monitor AMA/CMS/DHHS publications to detect changes that affect PCHP clinical and claims processes and will provide support as PCHP adds new programs and products.

Minimum Specifications

Education

• High School diploma or equivalent is required.

Experience

• Three years of coding experience in a health care or managed care setting.
• Three years of experience working with CPT/HCPCS, ICD-10-CM/PCS, and DRG coding guidelines and practices.
• Claims processing experience is preferred.
• Experience at a managed care organization is preferred.

Certification/Registration/Licensure

• Certified through the American Health Information Management Association (AHIMA) as one of the following: Certified Coding Specialist (CCS), Certified Coding Associate (CCA)
• OR Certified through American Association of Procedural Coders (AAPC) as one of the following: Certified Professional Coder (CPC), or Certified Professional Coder – Payer (CPC-P)

Skills or Special Abilities

• Knowledge of CPT/HCPCS, ICD-10-CM/PCS, and DRG coding guidelines and practices.
• Knowledge of medical terminology and anatomy is preferred.
• Strong analytical skills and a high level of attention to detail.
• Excellent verbal and written communication skills.
• Strong organizational skills and the ability to manage multiple competing projects and deadlines.
• Proficiency with Microsoft Office Excel, Word, and Outlook is required.
• Demonstrated ability to collaborate effectively and work as part of a team in a fast-changing environment.
• Proven ability to learn new areas of responsibility and adapt to change.
• Ability to work independently.
• Strong knowledge of Texas State Medicaid Guides & Handbooks - TMHP Provider Manuals, Uniform Managed Care Contract (UMCC), Uniform Managed Care Manual (UMCM), etc. is preferred.
• Knowledge of benefits configuration is preferred.

Responsibilities

• Provides coding expertise to and collaborates with various PCHP departments and vendors.
• Monitors AMA/CMS/DHHS publications to identify changes that impact PCHP clinical and claims processes and manage necessary changes through completion.
• Performs research to and provides answers to coding questions from PCHP stakeholders.
• Complies with all legal requirements regarding coding procedures and practices.
• Conducts audits and coding reviews to ensure accuracy within PCHP’s systems.
• Triages and troubleshoots coding related claims issues.
• Partners with PCHP departments and vendors on the implementation of new programs and products.
• Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines related to coding and keeps certification up to date.
• Other duties as assigned.

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 PCHP.
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 customer requirements. Seeks advice and guidance as needed to ensure proper understanding.

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Parkland Health and Hospital System 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. As part of our commitment to our patients and employees’ wellness, Parkland Health is a tobacco and smoke-free campus.