Medicaid Program Integrity Jobs in Tyler, TX (NOW HIRING)

US:TX:Tyler | Revenue Cycle Audit | Full Time

The Coding Integrity Specialist is responsible for ensuring accuracy and compliance in medical coding practices related to professional billing. This role involves auditing clinical documentation and medical records to validate CPT, HCPCS, and ICD-10-CM codes, ensuring adherence to federal regulations, payer policies, and internal standards. The auditor provides feedback and recommendations to providers and coding staff to improve coding quality and mitigate compliance risks. May be assigned to variable work areas throughout CTC. Works cooperatively as a team with all coding, education, revenue cycle, and management associates.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Conducts provider coding and documentation audits annually and as required by CPEA program guidelines.
• Performs both retrospective and prospective audits of professional billing codes to ensure compliance with CMS, AMA, OIG, and other regulatory standards.
• Applies ethical coding principles (CMS, AMA, CPT, ICD-10-CM), HCC coding standards, and revenue cycle knowledge to assess coding accuracy and billing integrity.
• Reviews clinical documentation to confirm correct assignment of CPT, HCPCS, and ICD-10 codes.
• Identifies coding trends, errors, and risk areas; recommends corrective actions and process improvements.
• Delivers written and verbal feedback to coders and providers; proposes topics for additional training or educational materials when necessary.
• Stays current with CMS and state-specific Medicaid coding and documentation guidelines.
• Maintains active certification through appropriate professional organizations.
• Continuously updates knowledge of the revenue cycle, practice management software, and electronic medical records through ongoing education.
• Supports department flexibility and adapts to evolving departmental needs.
• Contributes to achieving departmental performance goals and completes mandatory training requirements.
• Adheres to all standard operating procedures, tools, and workflows, maintaining an organized and efficient work environment.
• Provides mentoring and training on coding and billing integrity to new team members when needed.
• Complies with CHRISTUS Health's HIPAA policies to prevent unauthorized disclosure of Protected Health Information (PHI).
• Communicates clearly and professionally in alignment with the CHRISTUS Health mission and values.
• Conducts all responsibilities in accordance with CHRISTUS Health's Code of Ethics and diversity objectives.
• Performs other related duties as assigned.

Job Requirements:

Education/Skills

• Bachelor's degree in Health Information or related field, or equivalent combination of education/experience, preferred

Experience

• 5+ years of experience in CPT, HCPCS, and ICD-10-CM coding required
• 3+ years of audit experience in a multi-specialty physician office setting

Licenses, Registrations, or Certifications

• One or more of the following certifications are required:

• Registered Health Information Administrator (RHIA) from AHIMA
• Registered Health Information Technician (RHIT) from AHIMA
• Certified Professional Coder (CPC) from AAPC
• Certified Coding Specialist (CCS) from AHIMA

Work Schedule:

5 Days - 8 Hours

Work Type:

Full Time