HIM/Medical Records Analyst - FT (Remote)- ROC - South Texas Health System
About The Position
Serves as a key liaison for Texas facilities (STHS, DHL, FDRMC, NWT, and TMC) among Atlantic CBO (ATCBO), Coding, Health Information Management (HIM), Revenue Cycle, and Ancillary departments. The analyst resolves issues related to coding, claims, medical necessity edits, documentation compliance, and regulatory requirements. The role directly addresses complex coding and claims issues through real-time corrections and cross-department collaboration to support accurate, timely claim submission. The position focuses on Outpatient Code Editor (OCE/APC), National Corrective Coding Initiative (NCCI), and medical necessity edits. It also supports DNFB resolution, audit reviews, and prompt corrective action for coding and claims issues across multiple facilities. The analyst assists with DNFB initiatives and follow-up on holds or aging accounts, supports reviews of outpatient accounts audited by AI or outsourced providers, and monitors and maintains reports as needed. Advanced coding expertise, decision-making authority, and collaboration are required to resolve discrepancies in a timely manner and meet compliance, regulatory, and quality standards.
Requirements
- Excellent customer service skills.
- Clinical, Health Information Management/Coding, or Patient Financial experience.
- Advanced proficiency in Microsoft Office applications and other data-mining software.
- Advanced knowledge of ICD-10-CM, CPT, HCPCS, medical necessity guidelines, OCE/APC, NCCI, and Local Medical Review Policies (LMRP).
- Understanding of Medicare and Medical Assistance regulations as needed.
- Strong decision-making ability and capability to resolve complex coding and billing issues across multiple facilities.
- Excellent communication and collaboration skills, including the ability to interact with senior leadership, clinical staff, and coding and billing teams.
- Associate degree or higher in Health Information Management or a business-related field, or six years of coding experience in a healthcare setting in lieu of a degree.
- Coding certification required or to be obtained within 12 months of employment.
- High school diploma, GED, or higher education required.
- Commitment to the STHS Compliance Program and Code of Conduct.
Responsibilities
- Act as a liaison among Texas facilities, Atlantic CBO, Coding, HIM, Revenue Cycle, and Ancillary departments on coding, claims, medical necessity, documentation compliance, and regulatory issues.
- Resolve complex coding and claims issues through real-time corrections and collaboration across departments.
- Address Outpatient Code Editor (OCE/APC), NCCI, and medical necessity edits.
- Assist with DNFB initiatives and follow up on holds or aging accounts.
- Assist with audit reviews of outpatient accounts performed by AI or outsourced providers.
- Take corrective action for coding and claims issues across multiple facilities.
- Monitor and maintain reports as needed.
- Identify trends, recommend process improvements, and implement educational initiatives.
- Adhere to the STHS Compliance Program, Code of Conduct, policies, and procedures; attend required training and promptly report suspected compliance issues to the Compliance Officer.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
