Qureos Mentor

Houston Methodist

<div>At Houston Methodist, the System Clinical Documentation Improvement (CDI) Quality Specialist position is responsible for performing internal quality assurance reviews and provide on-going education to Clinical Documentation Specialist (CDS) staff to ensure compliance with national guidelines and policies for complete, accurate and consistent reporting which results in appropriate reimbursement and data integrity. This position reviews outcomes that are communicated to the team through various modes of education to improve the accuracy, integrity and quality of patient data, to ensure minimal variation in practices and to improve the quality of physician documentation within the body of the medical record to support code assignments. The CDI Quality Specialist provides onboarding training for new staff and education, based on quality reviews or existing staff. This position promotes a partnership between the concurrent clinical reviewers, medical record coders, and physicians to improve documentation and reimbursement.
<div>FLSA STATUS 
Exempt 
 
QUALIFICATIONS 
 
EDUCATION<ul><li>
Bachelor's degree from an accredited school of nursing
</li><li>Master of Science in Nursing or other master&rsquo;s degree in a related field preferred
</li></ul> 
EXPERIENCE<ul><li>
Three years of recent clinical documentation experience in an acute care hospital
</li><li>Academic hospital experience and coding experience preferred
</li></ul> 
LICENSES AND CERTIFICATIONS 
Required<ul><li>
RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure &ndash; Must obtain permanent Texas license within 60 days (if establishing Texas residency)
</li></ul>Preferred<ul><li>
CCS - Certified Coding Specialist (AHIMA) or</li><li>
CCDS - Clinical Documentation Specialists (ACDIS) or</li><li>
CDIP - Certified Documentation Integrity Practitioner (AHIMA)
</li></ul> 
SKILLS AND ABILITIES<ul><li>
Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through ongoing skills, competency assessments, and performance evaluations
</li><li>Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
</li><li>Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
</li><li>Demonstrates knowledge of DRG payor issues, appropriate DRG assignment alternatives, clinical documentation requirements, and referral policies and procedures
</li><li>Demonstrates knowledge of education modalities to enhance the way staff receive, process, and retain information in a learning environment
</li><li>Demonstrates accountability and professional development
</li><li>Requires excellent observation skills, analytical thinking, problem solving, plus good verbal and written communication
</li><li>Ability to interact and maintain regular significant contacts with other personnel throughout the institution (including but not limited to &ndash; physicians and their staff, mid-level providers, mid-level staff, coders, Case Managers); contacts methods may be in person, by telephone, or through correspondence
</li><li>Ability to display assertiveness while being even tempered, with a pleasing personality and the ability to communicate easily with others
</li>Working knowledge of Microsoft products including PowerPoint, Word, Excel and Outlook 
<li>
</li></ul> 
 
ESSENTIAL FUNCTIONS 
 
PEOPLE ESSENTIAL FUNCTIONS<ul><li>
Acts as documentation liaison with Health Information Management, Case Management, ancillary departments, physicians, staff, and management.
</li><li>Assists in ensuring Clinical Documentation Specialists (CDS) adherence with clinical documentation and coding guidelines and policies.
</li><li>Supports new and existing CDI staff development through training and education based on individual CDI staff needs.
</li></ul> 
SERVICE ESSENTIAL FUNCTIONS<ul><li>
Serves as subject matter expert and clinical resource for CDS and coding staff to clarify and interpret medical record documentation for complete and accurate coding and DRG assignment.
</li><li>Interacts and communicates with physicians and other providers as needed, educating them in the process of clarifying documentation in the medical record.
</li></ul> 
QUALITY/SAFETY ESSENTIAL FUNCTIONS<ul><li>
Ensures/Performs ongoing Quality Assurance reviews on each CDS based on Department Policies and Procedures and CDS Job Description, utilizing Training Manual, ICD-10-CM/PCS Coding Volumes, Coding Clinic, DRG Expert, AHIMA Compliant Query Guidelines and any other relevant sources and reports findings to leadership and staff.
</li><li>Evaluates the monitoring tools and applies action plans specific to the outcomes to improve the program.
</li><li>Supports the accuracy and completeness of clinical information used for measuring and reporting physician and hospital outcomes.
</li><li>Identifies special reviews or projects for review and clinical documentation improvement.
</li><li>Delivers education to ensure program quality standards are met.
</li></ul> 
FINANCE ESSENTIAL FUNCTIONS<ul><li>
Promotes clarification of clinical documentation, advocating for appropriate reimbursement for the patient care resources consumed and the level of service rendered.
</li></ul> 
GROWTH/INNOVATION ESSENTIAL FUNCTIONS<ul><li>
Generates and communicates new ideas and suggestions that improve quality, service, or finance.
</li><li>Maintains and applies up-to-date knowledge of official clinical documentation and coding guidelines, policies and procedures, and clinical/medical resources to assure knowledge and skills remain current.
</li><li>Develops and maintains comprehensive education programs for staff at all skill levels to enhance individual CDS knowledge.
</li>Makes recommendations for resources and tools to support education program. 
<li>
</li></ul> 
 
SUPPLEMENTAL REQUIREMENTS 
<ul>
WORK ATTIRE<li><ul><li>
Uniform: No
</li><li>Scrubs: No
</li><li>Business professional: Yes
</li><li>Other (department approved): Yes
</li></ul></li> 
ON-CALL* 
<li><ul><li>Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Events, etc) regardless of selection below.</li></ul></li><li><ul><li>
On Call* No
</li></ul></li> 
TRAVEL** 
**Travel specifications may vary by department**<li><ul><li>
May require travel within the Houston Metropolitan area No
</li><li>May require travel outside Houston Metropolitan area No
</li></ul></li></ul></div>QUALIFICATIONS 
 
EDUCATION<ul><li>
Bachelor's degree from an accredited school of nursing
</li><li>Master of Science in Nursing or other master&rsquo;s degree in a related field preferred
</li></ul> 
EXPERIENCE<ul><li>
Three years of recent clinical documentation experience in an acute care hospital
</li><li>Academic hospital experience and coding experience preferred
</li></ul> 
LICENSES AND CERTIFICATIONS 
Required<ul><li>
RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure &ndash; Must obtain permanent Texas license within 60 days (if establishing Texas residency)
</li></ul>Preferred<ul><li>
CCS - Certified Coding Specialist (AHIMA) or</li>
<li>CCDS - Clinical Documentation Specialists (ACDIS) or</li>
CDIP - Certified Documentation Integrity Practitioner (AHIMA) 
<li>
</li></ul> 
Company Profile:
Houston Methodist is one of the nation&rsquo;s leading health systems and academic medical centers. The health system consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the Texas Medical Center, seven community hospitals and one long-term acute care hospital throughout the Greater Houston metropolitan area. Houston Methodist also includes a research institute; a comprehensive residency program; international patient services; freestanding comprehensive care clinics, emergency care and imaging centers; and outpatient facilities. Come lead with us!
Houston Methodist is an Equal Opportunity Employer.</div>

System CDI Quality Specialist RN

<div>At Houston Methodist, the Senior Medical Assistant Certified (Sr. MA) position is responsible for functioning as an expert and demonstrates highly competent knowledge in the more technical and advances examinations and treatments necessary to communicate appropriately and carry out delegated medical assistant level tasks under the direct supervision of a Physician and/or Registered Nurse for assigned patient populations, for providing high quality support of patient care and services. This position oversees appropriate scope of practice (i.e. Hand Hygiene Validator, EMR super-user). The Sr. MA position assists with patient examinations, procedures, diagnostic studies, treatment, and dressing changes. This position also performs general administrative duties in accordance with CLIA, HIPAA, NCQA and government standards, as well as company policies and procedures. The Sr. MA position participates in patient care which is under the direction of a physician and within the scope of a medical assistant. This position may also be required to schedule patient appointments, ensure medical necessity compliance, and verify eligibility for care. Other duties for the Sr. MA position include independently and expertly performing the duties and responsibilities of preceptor and clinical resource to Medical Assistants, training and orienting others as appropriate.
<div>FLSA STATUS 
Non-exempt 
 
QUALIFICATIONS 
 
EDUCATION<ul><li>
High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)
</li></ul> 
EXPERIENCE<ul><li>
Five years medical assistant experience with highly complex, chronic disease management or in a specialty discipline
</li></ul> 
LICENSES AND CERTIFICATIONS 
Required<ul><li>
Certified Medical Assistant through AAMA, NAHP, NCCT. NHA or Registered Medical Assistant or EMT and</li><li>
BLS - Basic Life Support or Instructor (AHA) - American Heart Association
</li></ul>Preferred<ul><li>
CPT &ndash; Certified Phlebotomy Technician (ACA)
</li></ul> 
SKILLS AND ABILITIES<ul><li>
Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
</li><li>Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
</li><li>Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
</li><li>Knowledge of medical practice and care of patients and ability to assist with examinations, diagnostic and treatment procedures, knowledge of medical equipment and instruments
</li><li>Skill in developing and maintaining clinical quality assurance to maintain accurate medical records
</li><li>Demonstrate a learning attitude toward solving problems, using good reasoning and judgment
</li><li>Provide safe patient-centered, compassionate and competent care
</li><li>Proficient in computer skills for documentation and work-related purposes
</li><li>Completes required continuous training and education, including department-specific requirements. Maintain current certifications
</li><li>Ability to establish and maintain effective working relationships with patients, medical staff, coworkers and the public
</li><li>Ability to work with peers in a team situation
</li><li>Possess an understanding of the patient population as it relates to the clinical disease process
</li><li>Proficient in computer skills for documentation and work-related purpose
</li>Demonstrates advanced assessment competences appropriate for level of practice 
<li>
</li></ul> 
 
ESSENTIAL FUNCTIONS 
 
PEOPLE ESSENTIAL FUNCTIONS<ul><li>
Role models and promotes a positive work environment that actively assists interprofessional care team to achieve optimal department results. Makes contributions to the work effort as a whole, by leading and initiating problem resolution within the work unit. Facilitates teamwork by anticipating the need for assistance and responding positively to requests for assistance.
</li><li>Collaborates with all members of the interprofessional health care team by actively communicating and reporting pertinent patient care information and data in a comprehensive manner. Teaches peers to critically think by verbally expressing rationale for decisions and follows up consistently. Facilitates open, professional, communication to achieve mutual understanding, role modeling by example.
</li><li>Independently executes the duties and responsibilities of preceptor, serves as a clinical resource in the department, using advanced skills and competencies, guiding and mentoring colleagues&rsquo; though processes in order to provide optimal patient care. Provides structured feedback with examples.
</li></ul> 
SERVICE ESSENTIAL FUNCTIONS<ul><li>
Provides care to patients visiting the clinic under the direct supervision of a Physician, Registered Nurse, or clinic leadership procedures. Complete pre-visit planning workflow prior to visit whenever possible, including completing and/or requesting appropriate documentation. In collaboration with the provider team, anticipates the needs of the specific patient population.
</li><li>Communicates with patient, obtains and documents vital signs (i.e., pulse rate, temperature, blood pressure, weight, and height), chief complaint(s), preforms medication(s) review, discusses/reviews medical and social history (as appropriate). Documents, in patient&rsquo;s electronic medical record (EMR). care administered, all diagnostic measurements, treatments and procedures in accordance with established policies and procedures.
</li><li>Follow-up with patient as appropriate to ensure compliance with recommendations, medications, lab/x-ray results, special visits, PCP visits, dieticians, diabetes educators, etc. Ensures patient utilization and activation of MyChart.
</li><li>Provides care coordination with hospital, ED, consulting physicians and/or community resources whenever appropriate to including handling patient inquiries.
</li><li>Role models behaviors and skills, through peer-to-peer accountability, towards improving department score for patient satisfaction.
</li></ul> 
QUALITY/SAFETY ESSENTIAL FUNCTIONS<ul><li>
Reports observations, conditions and problems of patients to the physician and/or nurse. Recognizes abnormal clinical findings and reports them appropriately. Provides for the privacy of patients and families, keeping the safety of the patient in mind.
</li><li>Accurately performs routine tests on patients such as EKG, rapid strep, urinalysis, and urine pregnancy tests.
</li><li>Sterilizing instruments and equipment; prepare, clean and maintain exam and treatment rooms, as well as supplies and equipment.
</li></ul> 
FINANCE ESSENTIAL FUNCTIONS<ul><li>
Uses resources efficiently; does not waste supplies. Responsible for stocking exam rooms, taking inventory, and ordering supplies.
</li><li>Self-motivated to independently manage time effectively and prioritize daily tasks, minimizing incidental overtime. Role models effective time management and coordinates colleagues to meet the overall demands of the department.
</li></ul> 
GROWTH/INNOVATION ESSENTIAL FUNCTIONS<ul><li>
Develops skills of team members and continually assists with improving skills, performance and outcomes. Actively participates in professional development and the development of ongoing educational activities at a department-based level.
</li><li>Offers innovative solutions through participation in performance improvement activities.
</li>Completes and updates My Development plan on an on-going basis. 
<li>
</li></ul> 
 
SUPPLEMENTAL REQUIREMENTS 
<ul>
WORK ATTIRE<li><ul><li>
Uniform: Yes
</li><li>Scrubs: Yes
</li><li>Business professional: No
</li><li>Other (department approved): Yes
</li></ul></li> 
ON-CALL* 
<li><ul><li>Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Events, etc) regardless of selection below.</li></ul></li><li><ul><li>
On Call* No
</li></ul></li> 
TRAVEL** 
**Travel specifications may vary by department**<li><ul><li>
May require travel within the Houston Metropolitan area Yes
</li><li>May require travel outside Houston Metropolitan area No
</li></ul></li></ul></div>QUALIFICATIONS 
 
EDUCATION<ul><li>
High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)
</li></ul> 
EXPERIENCE<ul><li>
Five years medical assistant experience with highly complex, chronic disease management or in a specialty discipline
</li></ul> 
LICENSES AND CERTIFICATIONS 
Required<ul><li>
Certified Medical Assistant through AAMA, NAHP, NCCT. NHA or Registered Medical Assistant or EMT and</li>
<li>BLS - Basic Life Support or Instructor (AHA) - American Heart Association
</li></ul>Preferred
CPT &ndash; Certified Phlebotomy Technician (ACA) 
<ul><li>
</li></ul> 
Company Profile:
Houston Methodist Specialty Physician Group is an integral part of Houston Methodist&rsquo;s overall strategy to become one of the nation&rsquo;s leading academic medical centers. Established as a nonprofit corporation certified by the Texas State Board of Medical Examiners, the Specialty Physician Group enables physicians to maintain autonomy with respect to clinical practice while growing their practice within an academic environment.
Houston Methodist is an Equal Opportunity Employer.</div>

Senior Medical Assistant Certified- Neurology (Medical Center)

<div>At Houston Methodist, the Coding Specialist position is responsible for applying correct coding conventions to patient charge encounters in a clinical environment. This position abstracts diagnosis and procedural services from the physician record and reviews and corrects charge review and claim edit-related coding errors in the electronic health record.
<div>FLSA STATUS 
Non-exempt 
 
QUALIFICATIONS 
 
EDUCATION<ul><li>
High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)
</li><li>Completion of a Coding Certificate Program
</li></ul> 
EXPERIENCE<ul><li>
None
</li></ul> 
LICENSES AND CERTIFICATIONS 
Required<ul><li>
Requires CCA or CCS-P from AHIMA, CPC or CPCA from AAPC, or an approved Specialty Society Coding Certification
</li></ul> 
SKILLS AND ABILITIES<ul><li>
Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
</li><li>Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
</li><li>Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
</li><li>Knowledge of ICD-10, CPT, and HCPCS coding conventions
</li><li>Working knowledge of medical terminology, anatomy, and physiology
</li><li>Proficiency with Microsoft Office applications such as Word and Excel
</li><li>Must be a self-motivated individual with the ability to think critically and work independently
</li><li>Must have the ability to multi-task in a fast paced rapidly changing healthcare environment
</li>Demonstrates a high level of professionalism, customer service, and interpersonal skills and operates under strict confidentiality guidelines 
<li>
</li></ul> 
 
ESSENTIAL FUNCTIONS 
 
PEOPLE ESSENTIAL FUNCTIONS<ul><li>
Communicates regularly with physicians and Physician Organization Central Business Office (PO CBO) staff on clarification to accurately code diagnosis and procedures.
</li><li>Communicates any issues or pertinent information to the supervisor in a timely manner that impact diagnosis or coding charges.
</li><li>Provides support to other team members as advised by the manager and/or supervisor.
</li></ul> 
SERVICE ESSENTIAL FUNCTIONS<ul><li>
Responds to or clarifies internal requests from all business partners for medical coding information in a timely manner.
</li><li>Participates in coding round tables and in-services for continuing education.
</li><li>Cross trains and provides back up coverage of team members to ensure continuous coding and charge capture activities for PO departments.
</li></ul> 
QUALITY/SAFETY ESSENTIAL FUNCTIONS<ul><li>
Codes and abstracts medical records for reimbursement purposes from patient charts, physician documentation, and medical diagnostic and/or interventional reports using current coding conventions and guidelines and tools such as 3M encoder.
</li><li>Reviews and resolves coding claim edits.
</li></ul> 
FINANCE ESSENTIAL FUNCTIONS<ul><li>
Matches charge documents to charge review &amp; claim edit sessions, billing sheets, operative reports, and medical records to ensure correct codes are applied and billable services are captured.
</li><li>Works charge review and claim edit sessions within two business days of posting to the assigned work queues.
</li><li>Completes charge reconciliation assignments within the expected timeframe(s).
</li></ul> 
GROWTH/INNOVATION ESSENTIAL FUNCTIONS<ul><li>
Remains current on coding guidelines and regulations of various payors and specialty practices as directed by the supervisor and/or manager.
</li><li>Suggests front end coding charge review edits to manage and reduce the volume of back-end coding related denials.
</li>Participates in educational activities and attends scheduled accounts receivable (AR) risk assessment meetings as needed. 
<li>
</li></ul> 
 
SUPPLEMENTAL REQUIREMENTS 
<ul>
WORK ATTIRE<li><ul><li>
Uniform: No
</li><li>Scrubs: No
</li><li>Business professional: Yes
</li><li>Other (department approved): No
</li></ul></li> 
ON-CALL* 
<li><ul><li>Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Events, etc) regardless of selection below.</li></ul></li><li><ul><li>
On Call* No
</li></ul></li> 
TRAVEL** 
**Travel specifications may vary by department**<li><ul><li>
May require travel within the Houston Metropolitan area Yes
</li><li>May require travel outside Houston Metropolitan area No
</li></ul></li></ul></div>QUALIFICATIONS 
 
EDUCATION<ul><li>
High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)
</li><li>Completion of a Coding Certificate Program
</li></ul> 
EXPERIENCE<ul><li>
None
</li></ul> 
LICENSES AND CERTIFICATIONS 
Required
Requires CCA or CCS-P from AHIMA, CPC or CPCA from AAPC, or an approved Specialty Society Coding Certification 
<ul><li>
</li></ul> 
Company Profile:
Houston Methodist Specialty Physician Group is an integral part of Houston Methodist&rsquo;s overall strategy to become one of the nation&rsquo;s leading academic medical centers. Established as a nonprofit corporation certified by the Texas State Board of Medical Examiners, the Specialty Physician Group enables physicians to maintain autonomy with respect to clinical practice while growing their practice within an academic environment.
Houston Methodist is an Equal Opportunity Employer.</div>

Coding Specialist - Remote - Museum District

<div>At Houston Methodist, the Senior Inpatient Coder position is responsible for ensuring diagnostic and procedure codes are assigned accurately to inpatient, emergency room, therapy, and/or clinic encounters based upon documentation within the electronic medical record while maintaining compliance with established rules and regulatory guidelines.
<div>FLSA STATUS 
Non-exempt 
 
QUALIFICATIONS 
 
EDUCATION<ul><li>
Associate&rsquo;s degree or higher in a Commission on Accreditation for Health Informatics and Information Management accredited program or additional two years of experience (in addition to the minimum experience requirements listed below) in lieu of degree
</li></ul> 
EXPERIENCE<ul><li>
Three years of relevant inpatient coding experience or successful completion of the Houston Methodist Senior Inpatient Coder Transition Program
</li></ul> 
LICENSES AND CERTIFICATIONS 
Required<ul><li>
Must have one of the following: &bull; RHIT - Certified Health Information Technician (AHIMA) &bull; RHIA - Registered Health Information Administrator (AHIMA) &bull; CCS - Certified Coding Specialist (AHIMA)
</li></ul> 
SKILLS AND ABILITIES<ul><li>
Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
</li><li>Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
</li><li>Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
</li><li>Knowledge of coding classification systems, DRG and APC systems, official coding guidelines and coding compliance
</li><li>Knowledge of an electronic medical record and imaging systems
</li><li>Working knowledge of medical terminology, anatomy and physiology
</li><li>Proficiency with electronic encoder application
</li>Extensive PC knowledge - must be able to work effectively in common office software, coding software and abstracting systems 
<li>
</li></ul> 
 
ESSENTIAL FUNCTIONS 
 
PEOPLE ESSENTIAL FUNCTIONS<ul><li>
Interacts and communicates effectively with members of the coding team and HIM, physicians, IT, Patient Access and Business Office.
</li><li>Participates and provides good feedback during coding section meetings and coding education inservices.
</li><li>Takes initiative to assist others and shares knowledge with the coding group, business office, physicians and nurses on official coding guidelines.
</li></ul> 
SERVICE ESSENTIAL FUNCTIONS<ul><li>
Responds promptly to internal and external customer requests. Responds promptly to requests to code or review coded accounts for accuracy.
</li><li>Initiates queries with physicians to obtain or clarify diagnoses and/or procedures as appropriate, utilizing the established physician query process.
</li></ul> 
QUALITY/SAFETY ESSENTIAL FUNCTIONS<ul><li>
Responsible for assigning diagnostic and procedural codes to encounters of high complexity.
</li><li>Maintains and achieves the highest standards of coding quality by assigning accurate ICD-9-CM/ICD-10-CM/ICD-10-PCS codes utilizing an electronic encoder application in accordance with hospital policy and regulatory body guidelines.
</li><li>Maintains and achieves department standards of abstracting quality by reviewing accurate discharge disposition entered by nursing and corrects if necessary in order to achieve the highest quality of entered data. Assigns and enters physician identification number and procedure date correctly in the medical record abstracting system.
</li><li>Reviews medical record documentation and abstracts data into the encoder and EPIC/Electronic Health Record (EHR) to determine principal or final diagnosis, co-morbid conditions and complications, secondary conditions and procedures.
</li><li>Complies with the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official guidelines.
</li></ul> 
FINANCE ESSENTIAL FUNCTIONS<ul><li>
Utilizes time effectively. Consistently codes and abstracts at or above departmental standards of productivity while ensuring accuracy of coding.
</li><li>Supports meeting organizational goal for Accounts Receivables (AR) associated with uncoded accounts.
</li><li>Maintains coding timeframes within established departmental standards by ensuring all work items assigned to the coding queues are processed in a timely manner.
</li></ul> 
GROWTH/INNOVATION ESSENTIAL FUNCTIONS<ul><li>
Critically evaluates her or his own performance, accepts constructive criticism, and looks for ways to improve.
</li>Displays initiative to improve relative to job function. Contributes ideas to help improve quality of coding data and abstracting data. 
<li>
</li></ul> 
 
SUPPLEMENTAL REQUIREMENTS 
<ul>
WORK ATTIRE<li><ul><li>
Uniform: No
</li><li>Scrubs: No
</li><li>Business professional: Yes
</li><li>Other (department approved): No
</li></ul></li> 
ON-CALL* 
<li><ul><li>Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Events, etc) regardless of selection below.</li></ul></li><li><ul><li>
On Call* No
</li></ul></li> 
TRAVEL** 
**Travel specifications may vary by department**<li><ul><li>
May require travel within the Houston Metropolitan area Yes
</li><li>May require travel outside Houston Metropolitan area Yes
</li></ul></li></ul></div>QUALIFICATIONS 
 
EDUCATION<ul><li>
Associate&rsquo;s degree or higher in a Commission on Accreditation for Health Informatics and Information Management accredited program or additional two years of experience (in addition to the minimum experience requirements listed below) in lieu of degree
</li></ul> 
EXPERIENCE<ul><li>
Three years of relevant inpatient coding experience or successful completion of the Houston Methodist Senior Inpatient Coder Transition Program
</li></ul> 
LICENSES AND CERTIFICATIONS 
Required
Must have one of the following: &bull; RHIT - Certified Health Information Technician (AHIMA) &bull; RHIA - Registered Health Information Administrator (AHIMA) &bull; CCS - Certified Coding Specialist (AHIMA) 
<ul><li>
</li></ul> 
Company Profile:
Houston Methodist is one of the nation&rsquo;s leading health systems and academic medical centers. The health system consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the Texas Medical Center, seven community hospitals and one long-term acute care hospital throughout the Greater Houston metropolitan area. Houston Methodist also includes a research institute; a comprehensive residency program; international patient services; freestanding comprehensive care clinics, emergency care and imaging centers; and outpatient facilities. Come lead with us!
Houston Methodist is an Equal Opportunity Employer.</div>

Sr Inpatient Coder

<div>At Houston Methodist, the Research Coordinator II position is responsible for coordinating the day-to-day activities of research protocols as well as assessing and determining qualification of patients for research studies. Under minimal supervision, this position is responsible for ensuring accurate data collection, documentation, organization and safety of research participants, gathering patient data for clinical research activities via methods specified in the study protocol and performs general administrative duties supporting the study.
<div>FLSA STATUS 
Exempt 
 
QUALIFICATIONS 
 
EDUCATION<ul><li>
Bachelor&rsquo;s degree
</li></ul> 
EXPERIENCE<ul><li>
Four years of research experience
</li></ul> 
LICENSES AND CERTIFICATIONS 
Preferred<ul><li>
CCRC - Certified Clinical Research Coordinator (ACRP) or</li><li>
CCRP - Certified Clinical Research Professional (SOCRA)
</li></ul> 
SKILLS AND ABILITIES<ul><li>
Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
</li><li>Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
</li><li>Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
</li><li>Ability to work independently
</li><li>Capable of handling challenging/difficult situations
</li>Demonstrates sound judgment and executes above average analytical skills 
<li>
</li></ul> 
 
ESSENTIAL FUNCTIONS 
 
PEOPLE ESSENTIAL FUNCTIONS<ul><li>
Under the direction of the Principal Investigator (PI), drafts various communications with the Sponsor and/or regulatory documents to be sent to the Sponsor.
</li><li>Identifies and recruits clinical research subjects and monitors enrollment goals.
</li><li>May conduct in-services to floor nurses/physicians; assists in precepting new clinical research staff and educating other research staff regarding scientific aspects of studies.
</li><li>Teaches peers to critically think by verbally expressing rationale for decisions and follows up consistently. Uses peer-to-peer accountability towards improvement of department score for turnover/retention/employee engagement.
</li></ul> 
SERVICE ESSENTIAL FUNCTIONS<ul><li>
Participates in the Principal Investigator (PI) meetings.
</li><li>Schedules, coordinates, and participates in the pre-site visit and site initiation visits; coordinates study initiation. Obtains Informed Consent from study participant and documents appropriately.
</li><li>Obtains vital signs and performs phlebotomy per training and competence; monitors participants&rsquo; labs and notifies the PI of laboratory findings.
</li></ul> 
QUALITY/SAFETY ESSENTIAL FUNCTIONS<ul><li>
Prepares Institutional Research Board (IRB) documents under the direction of the PI, assists with answering IRB stipulations to obtain final approval; documents IRB approval and contract approval.
</li><li>Maintains and monitors source documentation and appropriate forms as per protocol for quality and accuracy, including participant records; assists with the quality assurance process. Adheres to internal controls established for the department.
</li></ul> 
FINANCE ESSENTIAL FUNCTIONS<ul><li>
Assists with the budget development and Medicare coverage analysis.
</li><li>Utilizes resources effectively and efficiently, demonstrating responsible financial stewardship. Manages own time effectively and prioritizes work to achieve maximum results in a timely manner.
</li></ul> 
GROWTH/INNOVATION ESSENTIAL FUNCTIONS<ul><li>
Assists PI and/or research nurse in the planning and design of source documents for protocol.
</li><li>Assists in developing procedures for laboratory collection and storage.
</li><li>Incorporates directions from other health care disciplines into clinical research protocols when reviewing patient eligibility; assists in eliciting relevant data from sources outside of the hospital.
</li>Proactively manages own professional development and completes My Development Plan. 
<li>
</li></ul> 
 
SUPPLEMENTAL REQUIREMENTS 
<ul>
WORK ATTIRE<li><ul><li>
Uniform: No
</li><li>Scrubs: Yes
</li><li>Business professional: No
</li><li>Other (department approved): Yes
</li></ul></li> 
ON-CALL* 
<li><ul><li>Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Events, etc) regardless of selection below.</li></ul></li><li><ul><li>
On Call* No
</li></ul></li> 
TRAVEL** 
**Travel specifications may vary by department**<li><ul><li>
May require travel within the Houston Metropolitan area No
</li><li>May require travel outside Houston Metropolitan area No
</li></ul></li></ul></div>QUALIFICATIONS 
 
EDUCATION<ul><li>
Bachelor&rsquo;s degree
</li></ul> 
EXPERIENCE<ul><li>
Four years of research experience
</li></ul> 
LICENSES AND CERTIFICATIONS 
Preferred<ul><li>
CCRC - Certified Clinical Research Coordinator (ACRP) or</li>
CCRP - Certified Clinical Research Professional (SOCRA) 
<li>
</li></ul> 
Company Profile:
Houston Methodist Academic Institute oversees the Education Institute and Research Institute. The Academic Institute aligns our research and education initiatives in service to the clinical mission, providing solutions that answer the call for new technologies and skills our clinicians need for patient care. Houston Methodist Education Institute coordinates our primary academic affiliation with Weill Cornell Medicine and other joint programs, including the Engineering Medicine Program at Texas A&amp;M University Intercollegiate School of Engineering Medicine. The Education Institute also oversees continuing medical education and graduate medical education, and supports trainees in residence for medical, nursing, allied health and research education programs. Houston Methodist Research Institute supports research programs and infrastructure that enable faculty across the system to bring new scientific discoveries to patients as rapidly as possible through the full cycle of a cure from conceptual bench research, to prototyping and development, to clinical trials and FDA approval. The Research Institute supports clinical research protocols and extramurally funded translational research programs.
Houston Methodist is an Equal Opportunity Employer.</div>

Research Coordinator II

<div>At Houston Methodist, the Research Coordinator position is responsible for coordinating the day-to-day activities of research protocols as well as assessing and determining qualification of patients for research studies. This position ensures accurate data collection, documentation, organization and safety of research participants.
<div>FLSA STATUS 
Exempt 
 
QUALIFICATIONS 
 
EDUCATION<ul><li>
Bachelor&rsquo;s degree
</li></ul> 
EXPERIENCE<ul><li>
Two years&rsquo; research experience
</li></ul> 
SKILLS AND ABILITIES<ul><li>
Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
</li><li>Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
</li><li>Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
</li><li>Sufficient in clinical and research data entry
</li><li>Capable of handling challenging/difficult situations
</li>Demonstrates sound judgment and executes analytical skills 
<li>
</li></ul> 
 
ESSENTIAL FUNCTIONS 
 
PEOPLE ESSENTIAL FUNCTIONS<ul><li>
Under the direction of higher level staff, conducts screening and interviews to evaluate patient eligibility in study.
</li><li>Promotes a positive work environment and contributes to a dynamic, team focused work unit that actively helps one other to achieve optimal department results. Collaborates with all members of the patient care team by actively communicating and reporting pertinent information as it relates to assigned system(s) in a comprehensive manner.
</li><li>Provides contributions towards improvement of department scores for employee engagement.
</li></ul> 
SERVICE ESSENTIAL FUNCTIONS<ul><li>
Responds promptly and accurately to customer complaints, inquiries, and requests for information and coordinate appropriate follow-up calls and/or appointments.
</li><li>Schedules research subject appointments for tests and procedures, such as laboratory tests, x-rays, and other studies specific for the research protocol.
</li><li>Compiles patient information, process, document and enter accurate information in Source Documents, Case Report Forms, Electronic Data Capture portals and Clinical Trial Management System following established procedures.
</li></ul> 
QUALITY/SAFETY ESSENTIAL FUNCTIONS<ul><li>
Maintains records for clinical study and regulatory documents.
</li><li>Under the direction of Research Nurse/Clinical Trial Manager/Physician, captures and reports Adverse Events (A/E) or Serious Adverse Events (SAE) to necessary regulatory authorities.
</li><li>Assists management with research records and regulatory maintenance.
</li></ul> 
FINANCE ESSENTIAL FUNCTIONS<ul><li>
Uses resources efficiently; does not waste supplies. Evaluates and reports on inventory levels. Self-motivated to independently manage time effectively and prioritize daily tasks.
</li><li>Maintains inventory of supplies necessary for the study.
</li></ul> 
GROWTH/INNOVATION ESSENTIAL FUNCTIONS<ul><li>
Maintains working knowledge of the research process and in the conduct of IRB approved research protocols. Follows International Conference on Harmonization (ICH)/Good Clinical Practice (GCP) guidelines.
</li>Seeks opportunities to expand learning beyond baseline competencies with a focus on continual development. Completes and updates My Development plan on an on-going basis. 
<li>
</li></ul> 
 
SUPPLEMENTAL REQUIREMENTS 
<ul>
WORK ATTIRE<li><ul><li>
Uniform: No
</li><li>Scrubs: Yes
</li><li>Business professional: No
</li><li>Other (department approved): Yes
</li></ul></li> 
ON-CALL* 
<li><ul><li>Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Events, etc) regardless of selection below.</li></ul></li><li><ul><li>
On Call* No
</li></ul></li> 
TRAVEL** 
**Travel specifications may vary by department**<li><ul><li>
May require travel within the Houston Metropolitan area No
</li><li>May require travel outside Houston Metropolitan area No
</li></ul></li></ul></div>QUALIFICATIONS 
 
EDUCATION<ul><li>
Bachelor&rsquo;s degree
</li></ul> 
EXPERIENCE
Two years&rsquo; research experience 
<ul><li>
</li></ul> 
Company Profile:
Houston Methodist Academic Institute oversees the Education Institute and Research Institute. The Academic Institute aligns our research and education initiatives in service to the clinical mission, providing solutions that answer the call for new technologies and skills our clinicians need for patient care. Houston Methodist Education Institute coordinates our primary academic affiliation with Weill Cornell Medicine and other joint programs, including the Engineering Medicine Program at Texas A&amp;M University Intercollegiate School of Engineering Medicine. The Education Institute also oversees continuing medical education and graduate medical education, and supports trainees in residence for medical, nursing, allied health and research education programs. Houston Methodist Research Institute supports research programs and infrastructure that enable faculty across the system to bring new scientific discoveries to patients as rapidly as possible through the full cycle of a cure from conceptual bench research, to prototyping and development, to clinical trials and FDA approval. The Research Institute supports clinical research protocols and extramurally funded translational research programs.
Houston Methodist is an Equal Opportunity Employer.</div>

Research Coordinator I

<div>
 Come lead with us at Houston Methodist Cypress Hospital
 
 
 At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent medical record review for medical necessity and level of care using nationally recognized acute care indicators and criteria as approved by medical staff, payer guidelines, CMS, and other state agencies. This position prospectively or concurrently determines the appropriateness of inpatient or observation services following review of relevant medical documentation, medical guidelines, and insurance benefits and communicates information to payers in accordance with contractual obligations. The URN position serves as a resource to the physicians and provides education and information on resource utilization and national and local coverage determinations (LCDs &amp; NCDs). This position collaborates with case management in the development and implementation of the plan of care and ensures prompt notification of any denials to the appropriate case manager, denials, and pre-bill team members, as well as management.
 
 
 
 FLSA STATUS
 
 
 
 Exempt
 
 
 
 
 QUALIFICATIONS
 
 
 
 
 
 EDUCATION
 
 
 
 <ul>
 <li>
 Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certifications, Licenses and Registrations section
 </li>
 <li>
 Bachelor&rsquo;s degree preferred
 
 
 </li>
 </ul>
 
 
 EXPERIENCE
 
 
 
 
 <ul>
 <li>
 Three years of hospital clinical nursing experience
 
 
 </li>
 </ul>
 
 LICENSES AND CERTIFICATIONS
 
 
 
 
 
 Required
 
 
 
 
 <ul>
 <li>
 RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure &ndash; Must obtain permanent Texas license within 60 days (if establishing Texas residency)
 
 
 </li>
 </ul>
 
 
 SKILLS AND ABILITIES
 
 
 
 
 <ul>
 <li>
 Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through ongoing skills, competency assessments, and performance evaluations
 </li>
 <li>
 Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
 </li>
 <li>
 Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
 </li>
 <li>
 Progressive knowledge of InterQual Level of Care Criteria or Milliman Care Guidelines and knowledge of local and national coverage determinations
 </li>
 <li>
 Recent work experience in a hospital or insurance company providing utilization review services
 </li>
 <li>
 Knowledge of Medicare, Medicaid, and Managed Care requirements
 </li>
 <li>
 Progressive knowledge of community resources, health care financial and payer requirements/issues, and eligibility for state, local, and federal programs
 </li>
 <li>
 Progressive knowledge of utilization management, case management, performance improvement, and managed care reimbursement
 </li>
 <li>
 Ability to work independently and exercise sound judgment in interactions with physicians, payers, and health care team members
 </li>
 <li>
 Strong assessment, organizational, and problem-solving skills
 </li>
 <li>
 Maintains level of professional contributions as defined in Career Path program
 </li>
 <li>
 Understands and applies federal law regarding the use of Hospital Initiated Notice of Non-Coverage (HINN), Ambulatory Benefit Notice (ABN), Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON), and Condition Code 44 (CC44)
 
 
 </li>
 </ul>
 
 
 ESSENTIAL FUNCTIONS
 
 
 
 
 
 PEOPLE ESSENTIAL FUNCTIONS
 
 
 
 <ul>
 <li>
 Establishes and maintains effective professional working relationships with patients, families, interdisciplinary team members, payers, and external case managers; listens and responds to the ideas of others.
 </li>
 <li>
 Collaborates with the access management team to ensure accurate and complete clinical and payer information. Educates members of the patient&rsquo;s healthcare team on the appropriate access to and use of various levels of care.
 </li>
 <li>
 Contributes towards improvement of department scores for employee engagement, i.e., peer-to-peer accountability.
 
 
 </li>
 </ul>
 
 
 SERVICE ESSENTIAL FUNCTIONS
 
 
 
 
 <ul>
 <li>
 Pro-actively participates as a member of the interdisciplinary clinical team to confirm appropriateness of the treatment plan relative to the patient&rsquo;s preference, reason for admission, and availability of resources. Participates in daily Care Coordination Rounds and identifies and communicates barriers to efficient utilization.
 </li>
 <li>
 Reviews H&amp;Ps and admitting orders of all direct, transfer, and emergency care patients designated for admission to ensure compliance with CMS guidelines regarding appropriateness of level of care.
 </li>
 <li>
 Identifies potentially unnecessary services and care delivery settings and recommends alternatives, if appropriate, by analyzing clinical protocols.
 </li>
 <li>
 Escalates appropriate cases to the Physician Advisor (or services) for appropriate second level review, peer-peer discussions, and payer denial- appeal needs. Consults with physician advisor as necessary to resolve progression-of-care barriers through appropriate administrative and medical channels.
 
 
 </li>
 </ul>
 
 
 QUALITY/SAFETY ESSENTIAL FUNCTIONS
 
 
 
 
 <ul>
 <li>
 Participates in quality improvement activities as stewards for resource utilization as it pertains to medical necessity and level of care. Promotes medical documentation that accurately reflects intensity of services, quality and safety indicators and patient&rsquo;s need to continue stay.
 </li>
 <li>
 Promotes the use of evidence-based protocols and/or order sets to influence high-quality and cost-effective care. Identifies areas for improvement based on an understanding of evidence-based practice/performance improvement projects based on these observations.
 </li>
 <li>
 Identifies and records episodes of preventable delays or avoidable days due to failure of the progression of the care process
 
 
 </li>
 </ul>
 
 
 FINANCE ESSENTIAL FUNCTIONS
 
 
 
 
 <ul>
 <li>
 Contributes to meeting department financial targets, with a focus on appropriate utilization and denial prevention. Utilizes resources with cost effectiveness and value creation in mind. Self-motivated to independently manage time effectively and prioritize daily tasks, assisting coworkers as needed.
 </li>
 <li>
 Performs review for medical necessity of admission, continued stay and resource use, appropriate level of care, and program compliance using evidence-based, nationally recognized guidelines. Manages assigned patients and communicates and collaborates with the case manager to assist with appropriate interventions to avoid denial of payment.
 </li>
 <li>
 Collaborates with the revenue cycle regarding any claim issues or concerns that may require clinical review during the pre-bill, audit, or appeal process.
 
 
 </li>
 </ul>
 
 
 GROWTH/INNOVATION ESSENTIAL FUNCTIONS
 
 
 
 
 <ul>
 <li>
 Identifies and presents areas for improvement in patient care or department operations and offers solutions by participating in department projects and activities.
 </li>
 <li>
 Seeks opportunities to identify self-development needs and takes appropriate action. Ensures own career discussions occur with appropriate management. Completes and updates the My Development Plan on an ongoing basis.
 
 
 </li>
 </ul>
 
 
 SUPPLEMENTAL REQUIREMENTS
 
 
 
 
 
 WORK ATTIRE
 
 
 
 <ul>
 <li>
 Uniform: No
 </li>
 <li>
 Scrubs: No
 </li>
 <li>
 Business professional: Yes
 </li>
 <li>
 Other (department approved): No
 
 
 </li>
 </ul>
 
 ON-CALL*
 
 
 
 <ul>
 <li>
 Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Events, etc) regardless of selection below.
 </li>
 <li>
 On Call* Yes
 
 
 </li>
 </ul>
 
 TRAVEL**
 
 
 
 <ul>
 <li>
 Travel specifications may vary by department**
 </li>
 <li>
 May require travel within the Houston Metropolitan area Yes
 </li>
 <li>
 May require travel outside Houston Metropolitan area No
 
 
 </li>
 </ul>
 
 
 QUALIFICATIONS
 
 
 
 
 
 EDUCATION
 
 
 
 <ul>
 <li>
 Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certifications, Licenses and Registrations section
 </li>
 <li>
 Bachelor&rsquo;s degree preferred
 
 
 </li>
 </ul>
 
 
 Required
 
 
 
 
 <ul>
 <li>
 RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure &ndash; Must obtain permanent Texas license within 60 days (if establishing Texas residency)
 
 
 </li>
 </ul>
 Houston Methodist is an Equal Opportunity Employer.
</div>

Utilization Review RN

Join Houston Methodist and explore 21   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.