Member Certification Manager jobs in Galveston, TX

MINIMUM QUALIFICATIONS

-A high school diploma or GED.

• Experience with communicating, training, and educating providers in proficiency.

• Knowledge of coding guidelines, anatomy and physiology, biology and microbiology, medical terminology, and medical abbreviations

• Specialty specific – (to be determined by coding manager when posting)

 CERTIFICATIONS (one is required):

CCS - Cert-Cert Coding Specialist American Health Information Management (AHIMA) Or

RHIA - Cert-Reg Health Inform. Admins American Health Information Management (AHIMA) Or

RHIT - Cert-Reg Health Inform. TECH American Health Information Management (AHIMA)

JOB SUMMARY

To provide the advanced skills necessary for proper coding of all pertinent diagnoses and procedures and to provide optimal DRG assignment after thorough review of medical record and analysis of DRG options.

ESSENTIAL JOB FUNCTIONS

• Selects low bill (>$150k) short stay records from EPIC WQ according to priority.

• Reviews all federally insured and other patient discharge encounters for accurate coding and sequencing of diagnoses and procedures.

• Correctly assigns ICD-10 -CM diagnoses and I C D - 1 0 - P C S procedure codes and enters appropriate codes into EPIC Encoder.

• Identifies responsible staff and resident physicians for each procedure coded.

• Always protects confidentiality of patient information.

• Participates in section meeting and office in-services.

• Attends and participates in coding education sessions.

• Keeps coding knowledge and skills current through attending continuing education activities and reviewing pertinent literature.

• Obtains required CEU’s for certification and completes any required education.

• Works coding related charge reviews/claim edits daily to ensure timely and accurate billing within filing deadlines.

• Responsible for productivity and quality standards to adhere with coding compliance and federal regulations.

Marginal or Periodic Functions:

• Performs related duties as required.

• Adheres to internal controls and reporting structure.

KNOWLEDGE/SKILLS/ABILITIES

• Strong interpersonal, written, and oral communication skills