Overview
At
Houston Methodist, the Audit & Onboarding Specialist position is responsible for planning, coordinating and completing complex documentation, coding and billing reviews. This position serves as a liaison between the Centralized Business Office (CBO) and clinical departments and provides direction and guidance to coders and clinical providers. The Audit & Onboarding Specialist is also responsible for ensuring successful onboarding of physicians regarding compliance in clinical documentation and coding.
PATIENT AGE GROUP(S) AND POPULATION(S) SERVEDRefer to departmental "Scope of Service" and "Provision of Care" plans, as applicable, for description of primary age groups and populations served by this job for the respective HM entity.
HOUSTON METHODIST EXPERIENCE EXPECTATIONS
- Provide personalized care and service by consistently demonstrating our I CARE values:
- INTEGRITY: We are honest and ethical in all we say and do.
- COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
- ACCOUNTABILITY: We hold ourselves accountable for all our actions.
- RESPECT: We treat every individual as a person of worth, dignity, and value.
- EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.
- Practices the Caring and Serving Model
- Delivers personalized service using HM Service Standards
- Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)
- Intentionally collaborates with other healthcare professionals involved in patients/customers or employees' experiential journeys to ensure strong communication, ease of access to information, and a seamless experience
- Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job
- Actively supports the organization's vision, fulfills the mission and abides by the I CARE values
Responsibilities
PEOPLE ESSENTIAL FUNCTIONS- Onboards new clinical practitioners, including but not limited to physicians, nurse practitioners, and physician assistants, to ensure they are documenting and coding appropriately for all services provided.
- Reviews coding accuracy and provides review results to the coding supervisor(s).
- Provides ongoing documentation, coding, and billing education to employees as needed.
- Collaborates with the CBO to communicate audit results. Delivers a list of exceptions needing corrective action.
SERVICE ESSENTIAL FUNCTIONS- Provides quality assurance, direction and guidance to departments.
- Demonstrates the components of the Houston Methodist Experience Service Standards and translates them into specific expectations to anticipate and meet customer needs.
- Ensures protection of private health and personal information. Adheres to all Health Insurance Portability and Accountability Act (HIPAA) compliance regulations.
QUALITY/SAFETY ESSENTIAL FUNCTIONS- Designs, delivers, and assesses educational materials for use in physician/staff training modalities.
- Monitors provider progress as directed by management to ensure adherence to regulations and policies and procedures.
- Designs and completes annual documentation and coding review plan. Delivers a summary outlining the review completed and the action items needed.
FINANCE ESSENTIAL FUNCTIONS- Ensures all charges performed are documented and billed appropriately in a timely manner.
- Reviews physician coding trends and identifies areas of opportunity for improved coding, documentation and/or charge capture.
- Audits new provider documentation and coding in a timely manner to ensure charges and payments are not delayed.
GROWTH/INNOVATION ESSENTIAL FUNCTIONS- Maintains current knowledge of coding industry standards, policies, and procedures.
- Assists in writing policies, protocols, and procedures to address billing compliance and documentation issues; including drafting and working with others to edit and adopt.
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.
Qualifications
EDUCATION- High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)
WORK EXPERIENCE- Seven years of progressive multi-specialty professional coding experience
License/Certification
LICENSES AND CERTIFICATIONS - REQUIRED- Must have one of the following:
- • CPC - Certified Professional Coder (AAPC)
- • CPC-H - Certified Professional Coder - Hospital (AAPC)
- • CPC-I - Certified Professional Coder Instructor (AAPC)
- • CCS - Certified Coding Specialist (AHIMA)
- • CCS-P - Certified Coding Specialist Physician-based (AHIMA)
KSA/ Supplemental Data
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
- Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
- Knowledge of International Classification of Diseases (ICD) coding, Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS)
- Knowledge of healthcare billing and Physicians at Teaching Hospitals (PATH) guidelines
- Computer skills to include proficiency in spreadsheet, word-processing, presentation, and compliance tracking software; ability to navigate healthcare regulatory websites
- Effective verbal and written communication skills; and effective presentation skills to a variety of audiences
- Demonstrates a positive, helpful and supportive attitude and demeanor
- Ability for professional handling of confidential/sensitive information
- Proven ability to analyze information and situations and to identify issues
- Ability to deal with difficult issues, maintain objectivity, use good judgment, and envision outcomes when making decisions
- Ability to analyze, identify and articulate identified trends and report trends succinctly in a clear and concise manner
- Ability to multi-task in a fast paced environment, prioritize projects and apply attention to detail
- Must be a self-motivated individual with the ability to think critically and work independently
SUPPLEMENTAL REQUIREMENTS
WORK ATTIRE
- Uniform No
- Scrubs No
- Business professional Yes
- Other (department approved) No
ON-CALL**Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.
TRAVEL****Travel specifications may vary by department**
- May require travel within the Houston Metropolitan area Yes
- May require travel outside Houston Metropolitan area No
Company Profile
Houston Methodist Specialty Physician Group - As one of the nation’s leading hospitals and academic medical centers Houston Methodist has brought together some of the nation’s leading experts in multiple specialties to serve our patients. As part of Houston Methodist Specialty Physician Group (HMSPG), these specialists not only provide excellent clinical care, but are on the forefront of research, developing leading-edge technologies and treatments, and teaching the medical pioneers of tomorrow. This combination of clinical service, research and academics ensures patients have access to the latest in treatments and technologies while providing the best in comprehensive patient care. Established as a non-profit corporation and certified by the Texas State Board of Medical Examiners, HMSPG enables physicians to maintain autonomy with respect to their clinical practice while growing their practice within an academic environment.
Originally posted on Himalayas
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