Coding Specialist 2 - Professional Fee

Coding

• 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).
• Assign correct CPT, ICD-10-CM, and HCPCS codes for professional charges, which could include E&M services; diagnostic services; procedural services; Charge Routers and 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 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 biling 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.
• 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;

• Certification in one of the following 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 anatomy/physiology, medical terminology, CPT and ICD-10-CM coding.
• Knowledge of CPT Outpatient coding guidelines. CCI edits and familiarity with medical necessity guidelines.
• Experience using EPIC, 3M encoder.
• Knowledge of CPT, ICD-10-CM, HCPCS, Federal Register, Federal and State insurance billing laws and Mandates.
• 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.
• Member of the American Academy of Professional Coders and Certified Professional Coder or AHIMA certification required upon hire.
• Must be able to pass internal coding test.