HIM/Medical Records Analyst - FT (Remote)- ROC - South Texas Health System
UHS Edinburg, Texas, United States
Hospitals and Health Care · 1,001-5,000 employees
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About the role
The analyst serves as a liaison between various departments to resolve complex coding, claims, and medical necessity issues. They are responsible for ensuring accurate claim submissions, supporting audit reviews, and maintaining compliance with regulatory standards.
What they look for
Requirements
Candidates must have an associate degree in Health Information Management or at least 6 years of relevant coding experience. Advanced knowledge of ICD-10-CM, CPT, and HCPCS coding systems is required, along with proficiency in Microsoft Office and data mining tools.
Full description
Responsibilities
POSITION SUMMARY: Serves as a key liaison for Texas facilities: STHS, DHL, FDRMC, NWT and TMC between Atlantic CBO (ATCBO), Coding, Health Information Management (HIM), Revenue Cycle, and Ancillary departments for issues related to coding, claims, medical necessity edits, documentation compliance, and regulatory requirements. This role will directly resolve complex coding and claims issues by performing real-time corrections and collaborating across departments to ensure accurate, timely claim submission. The position will focus on Outpatient Code Editor (OCE/APC), National Corrective Coding Initiative (NCCI), and medical necessity edits while addressing DNFB resolution, audit support, and immediate corrective action for coding and claims issues across multiple facilities. Assists with DNFB initiatives to address and/or follow-up on Holds or aging accounts. Assists with audit reviews of OP accounts performed by AI or outsourced. Monitors and maintains appropriate reports as needed. This position requires advanced coding expertise, decision-making authority, and strong collaboration skills to ensure that all coding and claims discrepancies are resolved in a timely manner to meet compliance, regulatory, and quality standards.
Qualifications
QUALIFICATIONS: 1. Excellent customer service skills required 2. Clinical, Health Information Management/Coding, or Patient Financial experience 3. Advance proficient in Microsoft Office applications and other data mining software with the ability to identify trends, recommend process improvements, and implement educational initiatives. 4. Advanced knowledge of ICD-10-CM, CPT, HCPCS, medical necessity guidelines, and Outpatient Code Editor (OCE/APC), NCCI, and Local Medical Review Policies (LMRP). 5. Understand Medicare & Medical assistance regulations as needed 1. Strong decision-making abilities and the capability to resolve complex coding and billing issues across multiple facilities. 2. Excellent communication and collaboration skills, with the ability to interact with senior leadership, clinical staff, and coding/billing teams. 3. Must demonstrate commitment and adherence to STHS’s Compliance Program and Code of Conduct through compliance with all policies and procedures, the Code of Conduct, attendance at required training and immediately reporting suspected compliance issue(s) to the Compliance Officer.
EDUCATION / LICENSURE: 1. Associates Degree or above in Health Information Management or business related field; 6 years of Coding experience in a Healthcare setting may be considered in lieu of a degree. 2. Coding certification required, or obtained within 12 months of employment. 3. High School diploma, GED or Higher Education required.
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