PB Coder (Coding Specialist ll)

Department Overview

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

• 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.
• Responsible for meeting performance standards set for accurate and timely submission of charges and coding for professional and facility services rendered at OHSU/HMC.
• 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.
  
  

Function/Duties of Position

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; facility services; and/or 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 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.

Required Qualifications

• 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 (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
  

Preferred Qualifications

• Accredited Coding Program required: AAPC Boot Camp, AHIMA Coding Boot Cam
• 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.
• 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.
• Must be able to pass internal coding test.
• Member of the American Academy of Professional Coders and Certified Professional Coder or AHIMA certification required upon hire.
  
  

Additional Details

Pay Range: $31.79 - $42.97 per hour

• Days of work are variable, could include rotating weekend days
• This position is a telecommuting position
• Department Core hours are: Monday thru Friday, 5:00am -10:00pm (with some flexibility available). Regularly scheduled work hours are required and are allowed within the core hours.
• Sitting at a computer for long periods of time.
  
  

All are welcome

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 503-494-5148 or aaeo@ohsu.edu.