Coding Specialist

This position provides support to the Department for billing physician's fees (Medicare Part B) and OHSU facility fees (Medicare Part A). This position is responsible for reviewing documentation to make sure it supports the levels or types of service billed and/or assigns a level of service based on the documentation. Ensure the documentation is in compliance with Medicare/Medicaid billing regulations and documentation guidelines, CPT documentation guidelines, and PATH rules. Responsible for meeting performance standards set for accurate and timely submission of charges for professional and facility services rendered at OHSU. Provide technical expertise regarding a broad range of third-party payer and reimbursement issues. Potential to provide physician education on billing and coding practices and advise physicians of coding changes or changes in regulations. Coding assignments will vary based on assignment and need. Focus on pain management facility and professional billing, critical care pro-fee billing, and anesthesiology pro-fee billing.

 

This level 3 coding positions provides support to the Enterprise Coding Department for coding highly specialized services. This position covers requires advanced coding experience in highly specialized areas of coding, and requires certification with AAPC or AHIMA.

• For Professional Services coding positions: Depending on the posted job need, this position is responsible for reviewing clinical documentation and applying the correct coding and modifiers to complex Specialty surgical procedures and/or other highly specialized services such as Orthopedics, Urology and may include integrated desks (i.e. coding both professional and facility services for the same patient). 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: Depending on the posted job need, this position is responsible for reviewing clinical documentation and applying the correct coding and modifiers to Inpatient records; Day Surgery/Observation surgical services; and/or other highly specialized services such as Infusions/Chemo. This position ensures that the documentation is in compliance with Medicare/Medicaid billing regulations, and provider documentation guidelines, CPT documentation and CMS coding guidelines. This 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 assignment will vary based on business needs or management assignment.
  

Coding

• Coding at 95% or above accuracy one of the following depending on posted job need:
• Facility:
  • Inpatient Coding
  • Outpatient Day Surgery/Observation services
  • Infusion/Chemotherapy services
• Professional:
  • Complex Surgical coding
  • Orthopedics
  • Urology
  • Integrated Desks (coding both facility and profee services for the same specialty)
• Abstract information from patient medical records to assign correct codes to inpatient records, outpatient surgical records, and/or observation cases. Work assigned charge sessions in assigned EPIC charge router work queues.
• Depending on posted job need, assign correct CPT, ICD-10-CM; HCPCS; or ICD-10-PCS and DRGs for facility and/or professional charges, which would involve complex procedure and diagnostic coding within highly specialized coding areas such as Inpatient Coding or surgical coding.
• Monitor activity for compliance with federal and/or state laws regarding correct coding set forth by CMS and Oregon Medical Assistance program (OMAP).
• Coordinate patient encounter billing information and ensure that all information is complete and accurate before submission. Enter coding and billing information into EPIC, establish and maintain procedures and other controls necessary in carrying out all coding and billing activity.
• Resolve with billing, any issues, coding denial requests or questions as part of coding denial process. Review clinical documentation of services to be coded in EPIC, and any other source of documentation available to ensure compliance with the Center for Medicare and Medicaid Services (CMS).
• 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.
• Develop and disseminate written procedures to facilitate and improve billing and coding processes for the department, and to train, support and mentor and orientate coding staff as necessary.
• Monitor coding and billing information from CMS guidelines, Professional licensing organizations, Internal communication memos, and transmittals from coding publishers and governmental agencies to advise facility and team of billing practice changes in CPT, ICD-10-CM, and HCPCS and ensure changes are implemented to maximize revenue and reflect medical evaluation of patient encounters.
• Make recommendations to coding leadership and implement remedial actions for problems. 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 of 4 years professional or hospital (depending on position) experience reviewing, abstracting, coding in ICD 10 CM or ICD 10 PCS, or CPT
• Knowledge of CPT, ICD-10-CM, HCPCS, Federal Register, Federal and State insurance billing laws and Mandates.
• Formal Medical Terminology (either prior to or upon employment).
• Proficiency with word processing and Excel spreadsheets.
• Excellent verbal and written communication skills with the ability to effectively communicate with individuals at all levels, physicians, nurses, administrative management, etc.
• Ability to work as a team player in a close proximity environment.
• Certification in one of the following (as indicated by the position description):
  • 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.

• Compliance with Code of Conduct, Respect in the workplace and Applicable policies, procedures and agreements related to position, department or OHSU as a whole

• Must be able to perform the essential functions of the position with or without accommodation

• Accredited Coding Program, Associates or Bachelor Degree; Specialized Coding Credential

• 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 anatomy/physiology, medical terminology.

• Knowledge of Outpatient coding guidelines. CCI edits and familiarity with medical necessity guidelines.

• Experience using EPIC, 3M encoder

   

Pay Range: $32.79 - $45.01 per hour (Commensurate with qualifications, experience and internal equity)

• Flex hours and remote work schedule available based on assignment after probationary period.
• Sitting at a computer for long periods of time.

Oregon Health & Science University values a diverse and culturally competent workforce. We are proud of our commitment to being an equal opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status. Individuals with diverse backgrounds and those who promote diversity and a culture of inclusion are encouraged to apply. To request reasonable accommodation contact the Affirmative Action and Equal Opportunity Department at or .