• Responsible for reviewing documents to identify all procedures and diagnosis. • Ensure the encounters have been coded correctly based on documents received. • Ensure encounters are coded using the most current coding guidelines. • Communicate and recognize inadequate or incorrect documentation. • Perform ongoing analysis of medical record documentation and codes assigned per CMS, CPT, and Ventra Health documentation guidelines. • Assign appropriate ICD-10-CM and CPT codes and modifiers according to documentation. • Document coding errors. • Assist with client/provider audits as needed.

• Reviewing documents to identify all procedures and diagnosis • Ensuring encounters have been coded correctly based on documents received • Using the most current coding guidelines for encounters • Communicating and recognizing inadequate or incorrect documentation • Performing ongoing analysis of medical record documentation and codes assigned per CMS, CPT, and Ventra Health documentation guidelines • Assigning appropriate ICD-10-CM and CPT codes and modifiers according to documentation • Performing MIPS review as needed • Performing Provider QA as needed • Documenting coding errors • Assisting coding management • Assisting with client/provider audits as needed • Reviewing work product of new coders in training, as needed • Providing feedback to coders on coding discrepancies/deficiencies, as needed • Providing feedback to coding manager on documentation deficiencies

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more. Explore more details on the Benefits of Working at HHS webpage. Functional Title: Nurse II Job Title: Nurse II Agency: Health & Human Services Comm Department: UR Wav & Comm Srvs Ran Mmt St Posting Number: 13275 Closing Date: 03/31/2026 Posting Audience: Internal and External Occupational Category: Healthcare Practitioners and Technical Salary Group: TEXAS-B-22 Salary Range: $4,801.16 - $7,761.50 Pay Frequency: Monthly Shift: Day Additional Shift: Telework: Eligible for Telework Travel: Up to 75% Regular/Temporary: Regular Full Time/Part Time: Full time FLSA Exempt/Non-Exempt: Exempt Facility Location: Job Location City: DENTON Job Location Address: 3612 E MCKINNEY ST RM 342-343 Other Locations: Austin; Georgetown; Longview; Marshall; San Antonio; Temple; Tyler; Waco MOS Codes: 290X,46AX,46FX,46NX,46PX,46SX,46YX,66B,66C,66E,66F,66G,66H,66N,66P,66R,66S,66T,66W Nurse II The Texas Health and Human Services Commission (HHSC) Medicaid CHIP Services (MCS) department seeks a highly qualified candidate to fill the position of Nurse II. MCS is driven by its mission to deliver quality, cost-effective services to Texans. This position makes a significant contribution to MCS’s mission by ensuring individuals served in our 1915(c) waiver programs and Community Attendant Services (CAS) receive the appropriate type and amount of service. The ideal candidate thrives in an environment that emphasizes teamwork to achieve goals, excellence through high professional standards and personal accountability, curiosity to continuously grow and learn, critical thinking for effective execution, and integrity to do things right even when what is right is not easy. Under the direct supervision of the Utilization Review Nurse Manager, the utilization review (UR) nurse: reviews and evaluates individual's records, individual service plans (ISPs), patient assessments, documentation related to Title XIX and Title XX, and state plan Medicaid community services for aged and disabled persons and individuals with intellectual and developmental disabilities (IDD); and conducts face to face interviews with individuals enrolled in the Community Attendant Services (CAS), Community Living Assistance and Support Services (CLASS), Deaf Blind with Multiple Disabilities (DBMD), Home and Community-based Services (HCS), and Texas Home Living (TxHmL) programs to determine service justification. Based on the in-person, teleconference or telephone interview assessment, desk review and evaluation of services, the UR nurse uses program knowledge and nursing expertise to determine appropriateness and quality of services, cost effectiveness of the service plan, validates determinations of health service needs, and makes service authorization decisions. The UR nurse conducts a variety of quality assurance reviews, and quality improvement studies. The UR nurse evaluates assigned Level of Need (LON) determinations in the IDD waiver programs when assigned to do so. This position works collaboratively with other UR nurses and regional staff to implement an effective statewide UR program and to ensure UR policies and procedures are applied consistently. This position works under the general supervision of the UR Nurse Manager, with moderate latitude for use of initiative and independent judgment. Essential Job Functions: Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned. Conducts desk reviews of required documentation for Health and Human Services Commission (HHSC), Medicaid Long Term Care Waiver Programs and Community Attendant Services (CAS). Participates in onsite, televideo, or telephonic interviews of the individuals identified in the random sample. Reviews, evaluates, and documents services provided to aged and disabled persons and persons with intellectual disability to validate service needs, service provision, determines appropriateness, quality, and cost effectiveness of services. (35%) Makes service authorization decisions on difficult, complicated, and/or targeted cases. (20%) Conducts a variety of quality assurance reviews and quality improvement studies and evaluates compliance with Medicaid program service requirements, state rules, regulations, policies, and procedures. (10%) Works collaboratively with other UR nurses through routine and ad hoc meetings to implement an effective statewide UR program and to ensure UR policies and procedures are applied consistently. (10%) Develops, provides resources and technical assistance to regional staff and providers. (10%) Testifies as the Subject Matter Expert (SME) in Medicaid fair hearings related to appealed service reductions or denials. (5%) Produces routine and specialized data and information for program reports. (5%) Works collaboratively across MCS to identify innovative and effective solutions for clients and staff (5%) Registrations, Licensure Requirements or Certifications: Must be licensed as a professional Registered Nurse (RN) in the state of Texas or a state that recognizes reciprocity through the Nurse Licensure Compact. Qualification as a Qualified Intellectual Disability Professional (QIDP) as defined in 42 Code of Federal Regulations 483.430(a) required. Must have a valid Texas Driver License. Knowledge Skills Abilities: Meets the criteria for designation as a Qualified Intellectual Disability Professional (QIDP) as defined in 42 Code of Federal Regulations 483.430(a) required. Knowledge of nursing health care laws, rules, standards, and regulations, medical diagnoses and procedures, community health and nursing care principles, quality management, utilization management, health care needs and services for elderly and disabled. Thorough knowledge of ID and other developmental disability related conditions, HCS, TxHmL, CLASS, DBMD, CAS, and ICF/ID program rules, service array and billing guidelines, local authority functions and waiver service system. Written and verbal communication skills necessary to consult, teach, and provide clear and concise directions and reports. Awareness of federal and state laws relating to long term care and other Medicaid and non-Medicaid services and programs. Knowledge of program planning, implementation and evaluation, and continuous quality improvement. Ability to communicate effectively, both orally and in writing. Ability to interpret statistical information. Ability to multi-task, handle stress and meet deadlines. Ability to work collaboratively across MCS to accomplish objectives. A keen attention to detail and the ability to implement creative solutions to problems. Able to balance team and individual responsibilities. Written and verbal communication skills necessary to consult, teach, and provide clear and concise directions and reports. Ability to: explain and interpret applicable health laws, rules, standards, and regulations; recognize patterns of medical necessity treatment, fraud, abuse, and neglect; use a personal computer, copier, Microsoft Office suite and Outlook e-mail; travel throughout the state as necessary. Initial Screening Criteria: Two-year experience working as a Registered Nurse (RN). Graduation from an accredited four-year college or university with major course work in nursing preferred, or from an accredited nursing program. BSN preferred, experience and education may be substituted for one another. Must meet the federal definition of a Qualified Intellectual and Developmental Disability Professional as defined in 42 Code of Federal Regulations 483.430(a). Must have at least one year of experience working directly with persons with intellectual disability or other developmental disabilities. Must be able to travel 75% of the time. Experience in utilization review, or quality assurance activities in long term services and supports for the aged and disabled preferred. Review our Tips for Success when applying for jobs at DFPS, DSHS and HHSC. Active Duty, Military, Reservists, Guardsmen, and Veterans: Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions. ADA Accommodations: In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview. Pre-Employment Checks and Work Eligibility: Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks. HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form Telework Disclaimer: This position may be eligible for telework. Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.

Responsibilities The Valley Health System has expanded into an integrated health network that serves more than two million people in Southern Nevada. Starting with Valley Hospital Medical Center in 1979, the Valley Health System has grown to include Centennial Hills Hospital Medical Center, Spring Valley Hospital Medical Center, Summerlin Hospital Medical Center , Henderson Hospital, and Valley Health Specialty Hospital. Benefit Highlights: - Competitive Compensation & Generous Paid Time Off - Excellent Medical, Dental, Vision and Prescription Drug Plans - 401(K) with company match and discounted stock plan - Career opportunities within VHS and UHS Subsidies - Challenging and rewarding work environment - Comprehensive education and training center Job Description: Responsible for preparing statistical reports, coding diseases and operations according to accepted classification systems and maintaining indices according to established policies and procedures. Qualifications ACUTE INPATIENT EXPERIENCE REQUIRED Education: Graduate as a Registered Health Information Administrator (RHIA) or a Registered Health Information Technician (RHIT) from an approved program by the American Health Information Management Association (AHIMA) preferred. Experience: Minimum 3 years recent Inpatient and Outpatient coding experience required. Coders must have the ability to crossover between all coding types (IP, OP, ASC, ER) and maintain a 95% coding accuracy across the board. -One to three years coding experience in an acute care setting—including inpatient, outpatient and ambulatory surgery. Technical Skills: Computer proficiency, analytical skills, ICD 9-CM/CPT coding knowledge. License/Certification: Credentialed as RHIT/RHIA or CCS required Other: Demonstrated knowledge of coding procedures, extensive reimbursement system knowledge, written and verbal communication skills. Must possess excellent knowledge of medical terminology, anatomy, physiology, and pathophysiology. EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success. Notice At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.