PB Diagnostic Coder Coding Specialist lll

This level 3 coding positions provides support to the Enterprise Coding Department for coding highlyspecialized services. This position covers requires advanced coding experience in highly specialized areas ofcoding 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 Interventional Radiology; Radiation Medicine; Cardiac Cath 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
    • Interventional Radiology
    • Radiation Medicine
    • Cardiac Cath
    • 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/orobservation cases. Work assigned charge sessions in assigned EPICcharge router work queues.
• Depending on posted job need assign correct CPT ICD10CM; HCPCS;or ICD10PCS and DRGs for facility and/or professional charges whichwould involve complex procedure and diagnostic coding within highlyspecialized coding areas such as Inpatient Coding or Surgical coding.
• Monitor activity for compliance with federal and/or state lawsregarding correct coding set forth by CMS and Oregon MedicalAssistance program (OMAP).
• Coordinate patient encounter billing information and ensure that allinformation is complete and accurate before submission. Enter codingand billing information into EPIC establish and maintain proceduresand other controls necessary in carrying out all coding and billingactivity.
• 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.

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 CPTCertification 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.

• Accredited Coding Program Associates or Bachelor Degree; Specialized Coding Credential
• Experience using an EMR.
• Experience using EPIC 3M encoder

Job Related KnowledgeSkills and Abilities(Competencies):

• Some college course work or education in classes related to anatomy/physiology medical terminology CPT and ICD10CM coding.
• Knowledge of OPPS guidelines and both CPT Inpatient and Outpatient coding guidelines. CCI edits and familiarity with medical necessity guidelines NCD and LCD requirements.
• Knowledge of CPT Outpatient coding guidelines. CCI edits and familiarity with medical necessity guidelines.
• Advanced knowledge of CPT ICD10CM 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.
• 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 to qualify as a Level 3.

• Department Core hours are: Monday Friday 5:00am 10:00pm (with some flexibility available).
• Regularly scheduled work hours are required and are allowed within the Core Hours.Days of work are variable could include rotating weekend days
• This position is a telecommuting positon

Benefits

• Comprehensive health care plans. Covered 100 for fulltime employees and 88 for dependents.
• $25K of term life insurance provided at no cost to the employee
• Two separate above market pension plans to choose from
• Vacation up to 200 hours per year depending on length of service prorated for parttime
• Sick Leave 96 hours per year prorated for parttime
• 8 paid holidays per year
• Substantial Trimet and CTran discounts
• Tuition Reimbursement
• Innovative Employee Assistance Program (EAP)