PB Diagnostic Coder (Coding Specialist lll) at Portland, OR (Downtown) – Portland, Oregon

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/or observation cases. Work assigned charge sessions in assigned EPIC charge router work queues.
• Depending on posted job need, assign correct CPT, ICD-10-CM; HCPCS; or ICD-10-PCS and DRGs for facility and/or 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).
• 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.

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

Job Related Knowledge, Skills and Abilities (Competencies):

• Some college course work or education in classes related to anatomy/physiology, medical terminology, CPT and ICD-10-CM 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, 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.
• 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.