HIM Medical Records Analyst FT ROC

UHS • Edinburg, TX

85d

About The Position

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.

Requirements

• Excellent customer service skills required.
• Clinical, Health Information Management/Coding, or Patient Financial experience.
• Advanced proficiency in Microsoft Office applications and data mining software.
• Advanced knowledge of ICD-10-CM, CPT, HCPCS, medical necessity guidelines, and coding policies.
• Understanding of Medicare & Medical assistance regulations.
• Strong decision-making abilities to resolve complex coding and billing issues.
• Excellent communication and collaboration skills.

Nice To Haves

• Coding certification required, or obtained within 12 months of employment.
• 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.

Responsibilities

• Serve as a key liaison for Texas facilities between various departments for issues related to coding and claims.
• Resolve complex coding and claims issues by performing real-time corrections.
• Collaborate across departments to ensure accurate and timely claim submission.
• Focus on Outpatient Code Editor (OCE/APC), National Corrective Coding Initiative (NCCI), and medical necessity edits.
• Address DNFB resolution, audit support, and immediate corrective action for coding and claims issues.
• Assist with DNFB initiatives to address and/or follow-up on Holds or aging accounts.
• Assist with audit reviews of OP accounts performed by AI or outsourced.
• Monitor and maintain appropriate reports as needed.

What This Job Offers

• Education Level: Associate degree
• Number of Employees: 1,001-5,000 employees