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Coding Quality Assurance Specialist job in Houston at Maxim Healthcare Staffing

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Coding Quality Assurance Specialist at Maxim Healthcare Staffing

Coding Quality Assurance Specialist

Maxim Healthcare Staffing Houston, TX (On Site) Full-Time


  • Assign and audits the accuracy of the ICD-10-CM and CPT codes to ambulatory, emergency center, observation, and daysurgery records for purposes of billing, research, and providing information to government and regulatory agencies. Ascertainsthe accuracy of the physicians' E/M and procedure coding to their documentation, and completes the auditing reporting tooland provides this feedback to the education team and/or provider. Incumbent may perform only certain of the followingresponsibilities depending on their particular work assignment.


Responsibility A: Assigns ICD-10-CM, ICD-10-PCS, and/or CPT codes.

  • Reviews and interprets physician documentation to appropriately assign diagnosis and procedure codes.• Communicates with and provides feedback to the education team and/or providers.• Reviews patient charges to determine necessary coding to complete the account.• Identifies principle and secondary diagnoses as well as procedure codes from the electronic medical record.• Utilizes the encoder or coding books to generate ICD-10-CM, ICD-10-PCS, and CPT codes for diagnosis and procedures.• Sequences diagnosis and procedures to generate appropriate billing.• Queries physicians to obtain diagnosis if not clearly provided in records.• Utilizes other available resources for assignment of codes as necessary (e.g., Epic, MIQS, Cardio IMS, and coding referencematerials).• Assists other coders in resolving coding problems.• Provides ICD-10 and CPT, for physician research projects, and for quality reporting purposes.

  • Responsibility B: Completes abstracts for records as appropriate.• Checks discharge disposition and attending physician for correctness.• Completes neonatal information regarding birth weight, gestational age, TPN, ECMO and number of ventilator days.• Extracts data regarding blood types/number of units and special unit stays.• Enters consultations as necessary.• Abstracts billable charges directly from operative reports, and/or physician encounter forms in a timely manner to ensurecharge capture is complete.• Processes spreadsheets including charge master e-bills.

  • Responsibility C: Assists in correction of problem accounts.• Identifies incorrect admit/discharge dates.• Identifies incorrect patient type.• Provides ICD-10 and CPT codes for Business Services and physician office requests regarding non-billed or non-reimbursedclaims.• Answers inquiries from outpatient clinics and ancillary departments for appropriate assignment of ICD-10 and CPT codes.• Provides provider education when necessary to aid in appropriate assignment of ICD-10 and CPT codes.• Identifies and reports charts filed under the wrong MRN.• Performs charge corrections when appropriate.• Provides quality customer service when resolving coding disputes.• Reviews coding denials to ensure coding is accurate per provider documentation.

  • Responsibility D: Reviews charts for completeness.• Identifies and reports charts requiring operative reports.• Identifies and reports charts with documentation.• Queries provider when documentation is needed for coding and billing purposes.

  • Responsibility E: Participates in education and maintains certification.• Facilitates coding education sessions (webinars, audio conferences, seminars, lunch and learn, newsletters) by researchingand presenting topics assigned by manager each month.• Prepares questions and provides examples of issues that have been discovered.• Obtains required number of CEUs for current certification and completes required education.

  • Responsibility F: Assists in auditing records.• Participates in peer coding reviews as necessary.• Re-reviews charts for correctness of diagnosis and procedure codes.• Identifies accounts opened in error, accounts needing admit/discharge dates, and billing discrepancies.• Resolves coding and compliance issues to ensure physician documentation criteria are in compliance with State andFederal regulations and guidelines.• Audits peer coding.• Audits physician coding.• Abstracts and audits all diagnosis, CPT, and PCS codes during abstraction.• Escalates and reports physician coding trends to management.

  • Responsibility G: Maintains concurrent coding for inpatient records.• Assigns diagnosis and procedure codes for patients in-house.• Assigns procedure codes for extended patient stays as requested by patient accounting for billing cycle purposes


At Maxim Healthcare Staffing, we firmly believe that our employees are the heartbeat of our organization and we are happy to offer the following benefits:

  • Competitive pay & weekly paychecks

  • Health, dental, vision, and life insurance

  • 401(k) savings plan

  • Awards and recognition programs

*Benefit eligibility is dependent on employment status.

About Maxim Healthcare Staffing

Maxim Healthcare Staffing has been making a difference in the lives of our patients, caregivers, and employees for more than 30 years. Our nationwide suite of services includes home healthcare, companion and behavioral care, healthcare staffing, and workforce solutions. Maxim's commitment to customer service, compassionate patient care, and filling critical staffing needs makes us a trusted partner wherever healthcare is needed.

Maxim Healthcare Staffing is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.

Recommended Skills

  • Auditing
  • Billing
  • Cpt Coding
  • Icd 10 Medical Classification
  • Medical Emergency
  • Service Quality
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