Audit & Onboarding Specialist - Hybrid (Museum District)

FLSA Status: Exempt

About the role

Come lead with us at Houston Methodist Specialty Physician Group. The Audit & Onboarding Specialist plans, coordinates, and completes complex documentation, coding, and billing reviews. This position serves as a liaison between the Centralized Business Office (CBO) and clinical departments, providing direction and guidance to coders and clinical providers. The specialist ensures successful onboarding of physicians regarding compliance in clinical documentation and coding.

Responsibilities

People

• Onboards new clinical practitioners, including physicians, nurse practitioners, and physician assistants, to ensure appropriate documentation and coding for all services provided.
• Reviews coding accuracy and provides results to the coding supervisor(s).
• Provides ongoing documentation, coding, and billing education to employees as needed.
• Collaborates with the CBO to communicate audit results and delivers a list of exceptions needing corrective action.

Service

• Provides quality assurance, direction, and guidance to departments.
• Demonstrates the components of the Houston Methodist Experience Service Standards and translates them into specific expectations to anticipate and meet customer needs.
• Ensures protection of private health and personal information and adheres to all Health Insurance Portability and Accountability Act (HIPAA) compliance regulations.

Quality/Safety

• Designs, delivers, and assesses educational materials for physician and staff training.
• Monitors provider progress as directed by management to ensure adherence to regulations and policies.
• Designs and completes an annual documentation and coding review plan, delivering a summary outlining the review and action items needed.

Finance

• Ensures all charges performed are documented and billed appropriately in a timely manner.
• Reviews physician coding trends and identifies areas of opportunity for improved coding, documentation, and/or charge capture.
• Audits new provider documentation and coding in a timely manner to ensure charges and payments are not delayed.

Growth/Innovation

• Maintains current knowledge of coding industry standards, policies, and procedures.
• Assists in writing policies, protocols, and procedures to address billing compliance and documentation issues, including drafting and editing.

Requirements

• High School diploma or equivalent (e.g., GED, verification of homeschool equivalency, partial or full completion of post-secondary education).
• Seven years of progressive multi-specialty professional coding experience.

Qualifications

Licenses and Certifications

Required: One of the following certifications:

• CPC - Certified Professional Coder (AAPC)
• CPC-H - Certified Professional Coder - Hospital (AAPC)
• CPC-I - Certified Professional Coder Instructor (AAPC)
• CCS - Certified Coding Specialist (AHIMA)
• CCS-P - Certified Coding Specialist Physician-based (AHIMA)

Skills and Abilities

• Demonstrates skills and competencies necessary to safely perform the assigned job, determined through ongoing assessments and evaluations.
• Proficient in speaking, reading, and writing English to perform essential job functions impacting patient or employee safety.
• Effectively communicates with patients, physicians, family members, and coworkers in a customer-focused manner.
• Knowledge of International Classification of Diseases (ICD) coding, Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS).
• Knowledge of healthcare billing and Physicians at Teaching Hospitals (PATH) guidelines.
• Proficiency in spreadsheet, word-processing, presentation, and compliance tracking software; ability to navigate healthcare regulatory websites.
• Effective verbal, written, and presentation skills for diverse audiences.
• Positive, helpful, and supportive attitude with professional handling of confidential/sensitive information.
• Ability to analyze information, identify issues, and articulate trends clearly and concisely.
• Ability to handle difficult issues, maintain objectivity, use good judgment, and envision outcomes when making decisions.
• Ability to multi-task in a fast-paced environment, prioritize projects, and apply attention to detail.
• Self-motivated with the ability to think critically and work independently.

Schedule

• May require travel within the Houston Metropolitan area.
• On-call during emergencies (e.g., disaster, severe weather events) may be required.

Work Attire

• Business professional attire required.