Department of Medicine Coder; Coding Specialist ll

Department Overview

This level 2 coding position provides support to the Enterprise Coding Department for coding of physician’sfees and/or facility fees. This position requires experience in coding and requires certification with AAPC orAHIMA.

• For Professional Services coding positions:
  This position is responsible for reviewing clinical documentation and applying the correct coding and modifiers to evaluation and management services and non-surgical procedural services. This position ensures that the documentation supports the levels or types of service billed, ensures the documentation is in compliance with Medicare/Medicaid billing regulations, and provider documentation guidelines, CPT documentation and CMS coding guidelines.
• For Facility Services coding positions:
  This position is responsible for reviewing documentation of outpatient diagnostic and ancillary services for diagnostic radiology, pathology, and other ancillary facility services s position provides support to the Enterprise Coding Department for abstracting of records, coding, and charge router submission of Facility services rendered at OHSU.
• Responsible for meeting performance standards set for accurate and timely submission of charges and coding for professional and facility services rendered at OHSU.
• Working in collaboration with Enterprise Coding Leadership and billing departments, provide technical expertise regarding a broad range of third-party payer and reimbursement issues.
• Orient peer coders or new hires to specified coding assignments.
• Requires maintaining an hourly productivity standard and quality standards as set by Enterprise Coding and based on Industry Standards.
• Will require attendance of Enterprise Coding and Clinical Department meetings via conference call and Webex.
• Coding Work Queue assignments will vary based on business needs or management assignment

Coding:

• Review clinical documentation of services to be coded in EPIC, and any other source of documentation available to ensure compliance withthe Center for Medicare and Medicaid Services (CMS).
• Assign correct CPT, ICD-10-CM, and HCPCS codes for facility and/or professional charges, which could include E&M services; diagnostic services; procedural services; facility services; and/or Charge Router sand Charge entry.
• Establish and maintain procedures and other controls necessary in carrying out all procedure and diagnostic coding and insurance billing activity for applicable work queues assigned in facility and/or professional services at OHSU.
• Monitor activity for compliance with federal and/or state laws regarding correct coding set forth by CMS and Oregon Medical Assistance program (OMAP).
• Coordinate all billing information and ensure that all information is complete and accurate.
• Ability to maintain supportive and open communication with coding supervisor and team leads regarding coding issues and priority coding responsibilities assigned.
• Develop and disseminate written procedures to facilitate and improve billing and coding processes for the department, and to train, support,orientate, and mentor coding staff as necessary.

Department support:

• Serve as a resource to ERC outpatient coding leadership and coding team for a broad range of billing policy and procedure issues.
• Attends coding meetings and seminars and shares knowledge with other coders. Participates in EC Huddles.
• In collaboration with Enterprise Coding Leadership, develop and disseminate written procedures to facilitate and improve billing and documentation processes.
• In collaboration with Leadership, make recommendations and implement remedial actions for problems
• Monitor coding and billing information from newsletters, memos, and transmittals from coding publishers and government agencies to advise physicians of billing practice changes in CPT, ICD-10-CM,and HCPCS
• Participate in Enterprise Coding education sessions, Kaizen events, maintain CEUs, stay informed of current trends in coding.

Perform other duties as assigned.

• High School diploma or GED.
• Minimum two years of hospital or professional services (dependent on position) experience reviewing, abstracting, and coding medical records using ICD-10-CM and CPT coding;
• Coding certification from AAPC or AHIMA:
  • Registered Health Information Administrator (RHIA),
  • Registered Health Information Technician (RHIT),
  • Certified Coding Specialist (CCS) through the American Health Information Management Association (AHIMA).
  • Active AHIMA membership may be required for some positions.
  • Certified Professional Coder (CPC) through the American Academy of Professional Coders; OR equivalent certification.

• Accredited Coding Program required: AAPC Boot Camp, AHIMA Coding Boot Camp
• Knowledge of OPPS guidelines and both CPT Inpatient and Outpatient coding guidelines. CCI edits and familiarity with medical necessity guidelines, NCD and LCD requirements.
• Experience using an EMR.
• Some college course work or education in classes related to…