Job Description

About CLS Health

CLS Health is a growing healthcare system in Houston, Texas that is taking a different approach to healthcare. We are a physician-led healthcare group that focuses on providing patients with holistic, multispecialty care. We're a dynamic team on a mission to provide better healthcare options for Houstonians!

Assigns and aligns predefined codes, tabulates the data into the computer system, generates new codes, resolves edits and denials, and maintains proper records in accordance with CLS guidance and procedures. Conducts regular reviews to ensure billing is timely, accurate, and in compliance.

• Assist with implementing and maintaining system-wide billing and coding quality audits.
• Understands, interprets and applies coding guidelines for coding audits. Review of medical records to determine coding accuracy of all documented diagnoses and procedures. Reviews claims to validate submitted codes and abstracted data including but not limited to ICD-10-CM codes, CPT’s, and HCPCS codes, which all impact reimbursement.
• Assure appropriateness and accurate of coding assignments in accordance with federal coding regulations and guidelines.
• Identifies documentation issues (lacking documentation, missed physician queries, etc.) that impact coding accuracy. Clearly communicates (verbally and in written reports or summaries) opportunities for documentation improvement related to coding issues.
• Stays current with AMA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM, CPT, and HCPCS coding. Completes online education courses and attends mandatory coding workshops and/or seminars (ICD-10-CM, HCPCS and CPT updates) for all specialties (e.g. OPPS, IPPS) coding. Reviews AMA, CMS ASC Payment System, and CPT quarterly coding update publications.
• Evaluate the effectiveness of internal controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements and guidelines related to professional and facility fee documentation, coding and billing, including CMS and OIG compliance standards.
• Review the EMR system to ascertain the accuracy of the physicians E/M, Diagnosis and Procedure coding based on their documentation and updating this information either in our reporting system or a spreadsheet.
• Review daily provider notes and work with Providers to ensure all notes meet documentation requirements.
• Performs additional duties as required or assigned

Benefits:

• 401(k)
• 401(k) matching
• Dental Insurance
• Disability insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Requirements

• 2+ years' experience as an auditor/coder within a health care organization. Both inpatient and outpatient coding required.
• Knowledge of auditing concepts and principles.
• Advanced knowledge of medical coding and billing systems and regulatory requirements
• Excellent verbal/written communication skills.
• Proficiency with Microsoft Word, Excel and Power Point.
• Ability and willingness to provide one-on-one provider education a plus.