Surgery Coder 3 (Coding Specialist 3)

Coding

• Coding at 95% or above accuracy for Complex Surgical coding, General Surgery, Palstics Sugery, Bariatrics Surgery, GI, Potential other Surgical areas depending on needs of dept.
• 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.
• Assign correct CPT, ICD-10-CM; HCPCS; or ICD-10-PCS and DRGs for 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).
• 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.

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.
• Attend coding meetings and seminars and share knowledge with other coders. Participates in EC Huddles.
• In collaboration with Leadership, make recommendations and implement remedial actions for problems.
• 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 of 4 years professional experience reviewing, abstracting, coding in ICD 10 CM or ICD 10 PCS, or CPT.

• Certification in one of the following Coding certifications 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).
  • OR equivalent certification.
• Active AHIMA membership or Certified Professional Coder (CPC) through the American Academy of Professional Coders.

• 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.
• Advanced 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.
• Must be able to pass internal coding test to qualify as a Level 3.