Outpatient Coding QA & Reimbursement Supervisor
Harris Health System is the public healthcare safety-net provider established in 1966 to serve the residents of Harris County, Texas. As an essential healthcare system, Harris Health champions better health for the entire community, with a focus on low-income uninsured and underinsured patients, through acute and primary care, wellness, disease management and population health services. Ben Taub Hospital (Level 1 Trauma Center) and Lyndon B. Johnson Hospital (Level 3 Trauma Center) anchor Harris Health’s robust network of 39 clinics, health centers, specialty locations and virtual (telemedicine) technology. Harris Health is among an elite list of health systems in the U.S. achieving Magnet® nursing excellence designation for its hospitals, the prestigious National Committee for Quality Assurance designation for its patient-centered clinics and health centers and its strong partnership with nationally recognized physician faculty, residents and researchers from Baylor College of Medicine; McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); The University of Texas MD Anderson Cancer Center; and the Tilman J. Fertitta Family College of Medicine at the University of Houston.
Job Summary
This role leads and supports outpatient coding and clinical documentation improvement by supervising audit and reimbursement teams, driving accuracy, and ensuring compliance with OPPS and CMS guidelines. The position develops performance scorecards, manages workflows for audits and denials, and delivers targeted education to enhance coding quality and reduce compliance risk. Acting as a key resource for coding queries and quality reporting, this role fosters collaboration across departments and promotes continuous professional development through CEU-eligible training initiatives.
Minimum Qualifications
Degrees:
- Bachelors: Health Information Management and/or equivalate (Preferred)
- Associates: Health Information Management
Licenses & Certifications:
- Registered Health Information Administrator (RHIA) (Preferred)
- Registered Health Information Technician (RHIT)
- Certified Coding Specialist (CCS)
- Certified Outpatient Coder (COC)
Work Experience:
- Five (5) Years of Experience in Outpatient Coding and Training.
Management Experience:
- Three (3) Years of Experience in Leadership, Supervisory, or Auditing.
Communication Skills:
- Above Average Verbal Communication (Heavy Public Contact)
- Exceptional Verbal (Public Speaking)
- Writing/Correspondence
- Writing/ Reports
Job Attributes
Knowledge/Skills/Abilities:
- Analytical Abilities
- Design
- Medical Terms
- Research Knowledge and Abilities
- Statistical Knowledge and Abilities
Work Schedule:
- Eligible for Telecommute
- Flexible
Other Special Requirements
Other Requirements:
- Microsoft Suite: MS Word, MS PowerPoint, MS Excel, MS Outlook, MS Access, MS Project
- Detailed knowledge of coding conventions and rules established by the American Medical Association (AMA), the Center for Medicare and Medicaid Services (CMS), the ICD-10-CM Official Coding Guidelines, and AHIMA for assignment of diagnostic and procedural codes.
- Detailed knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology.
- Detailed knowledge of classification systems of ICD-10 CM and PCS nomenclature, coding rules, guidelines, and proper sequencing.
- Knowledge of JCAHO, Privacy Act of 1974, and HIPAA standards affecting medical records and their impact on reimbursement.
- Knowledge of ethical coding principles and revenue cycle activities.
- Skill in interpreting and applying ethical coding standards, understanding federal and state laws and regulations, and following professional practice standards for health care organization coding compliance program activities.
- Detailed knowledge of Clinical Documentation Improvement practices from Association of Clinical Documentation Integrity Specialists (ACDIS).
- Proficient in compliant query practices.
- Detailed comprehension of AHRQ quality indicators and manual guidelines along with qualifying inclusionary and exclusionary conditions.
- Equipment Operated: Regular office equipment and 3M 360 encoder interfaced with EPIC electronic medical record billing system