South Texas Health System · 1 day ago
HIM Med Rec Analyst FT ROC
Edinburg, TX
Full-time
Onsite
Senior Level
6+ years expSouth Texas Health System is seeking a HIM Med Rec Analyst to serve as a key liaison between various departments for coding and claims issues. The role focuses on resolving complex coding discrepancies and ensuring compliance with regulatory standards across multiple facilities.
Health CareHealth DiagnosticsMedical
Responsibilities
Serves as a key liaison for Texas facilities: STHS, DHL, FDRMC, NWT and TMC between Atlantic CBO (ATCBO), Coding, Health Information Management (HIM), Revenue Cycle, and Ancillary departments for issues related to coding, claims, medical necessity edits, documentation compliance, and regulatory requirements
This role will directly resolve complex coding and claims issues by performing real-time corrections and collaborating across departments to ensure accurate, timely claim submission
The position will focus on Outpatient Code Editor (OCE/APC), National Corrective Coding Initiative (NCCI), and medical necessity edits while addressing DNFB resolution, audit support, and immediate corrective action for coding and claims issues across multiple facilities
Assists with DNFB initiatives to address and/or follow-up on Holds or aging accounts
Assists with audit reviews of OP accounts performed by AI or outsourced
Monitors and maintains appropriate reports as needed
This position requires advanced coding expertise, decision-making authority, and strong collaboration skills to ensure that all coding and claims discrepancies are resolved in a timely manner to meet compliance, regulatory, and quality standards
Qualification
Required
Excellent customer service skills required
Clinical, Health Information Management/Coding, or Patient Financial experience
Advance proficient in Microsoft Office applications and other data mining software with the ability to identify trends, recommend process improvements, and implement educational initiatives
Advanced knowledge of ICD-10-CM, CPT, HCPCS, medical necessity guidelines, and Outpatient Code Editor (OCE/APC), NCCI, and Local Medical Review Policies (LMRP)
Understand Medicare & Medical assistance regulations as needed
Strong decision-making abilities and the capability to resolve complex coding and billing issues across multiple facilities
Excellent communication and collaboration skills, with the ability to interact with senior leadership, clinical staff, and coding/billing teams
Must demonstrate commitment and adherence to STHS's Compliance Program and Code of Conduct through compliance with all policies and procedures, the Code of Conduct, attendance at required training and immediately reporting suspected compliance issue(s) to the Compliance Officer
Associates Degree or above in Health Information Management or business related field; 6 years of Coding experience in a Healthcare setting may be considered in lieu of a degree
Coding certification required, or obtained within 12 months of employment
High School diploma, GED or Higher Education required
Company
South Texas Health System
South Texas Health System (STHS) is a regional multi-hospital system that has earned excellence in providing quality healthcare.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Jessica Becker
Chief Executive Officer
Carlos Guajardo
Chief Financial Officer
Recent News
News-Medical.Net
2025-04-11
2025-03-29
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