Coding Specialist 2 - Professional Fee

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.

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.

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.