Medical Coding Specialist

Current employees: Please apply through the employee portal to be considered for this opportunity.

Pay Range:

$30.14 - $36.91 Hourly

Department:

Health Department

Job Type:

Regular Represented

Exemption Status:

United States of America (Non-Exempt)

Closing Date (Open Until Filled if No Date Specified):

The Opportunity:

THIS WORK MATTERS!

This recruitment is "Open Until Filled" to allow for a deeper candidate pool. Applicants will be reviewed every week, starting 08/05/2025.

The primary purpose of the Medical Coding Specialist - (Finance Specialist 1) is to analyze coding, charges and provider documentation for Behavioral Health Services with the goal of providing technical assistance, training for staff as well as optimizing revenue, ensuring compliant coding practices, and increasing the volume of accurate claims for reimbursement. 

Knowledge, Skills and Abilities (KSA): Certified Medical Coder issued from AAPC or AHIMA (REQUIRED).

As the Medical Coding Specialist, other duties will include:

Quality Assurance and Compliance

• Provide customer service by telephone, email, and virtually/in-person to Behavioral Health staff and leadership to aid them in understanding healthcare reimbursement, documentation and coding/charges. 

• Assist staff and internal customers with current coding and compliance guidelines, procedures and related laws. 

• Assist in the internal development of technical assistance guides, rate sheets, policies and procedures related to coding, billing, documentation, and re-billing to meet department and external partner requirements. 

• Work with and apply Oregon Health Authority (OHA) and Coordinated Care Organization (CCO)/CareOregon rules and regulations; apply expertise in coding guidelines and federal regulations. 

• Assist with transition from Evolv to EPIC electronic health record. 

• Provide technical assistance around coding requirements to aid QM Billing Team in training and educating staff on selecting codes for services rendered. 

• Participate in internal projects related to improving efficiencies and processes.

Review and Analysis - Fee Coding and Charges

• Review and analyze Behavioral Health charts to ensure accurate clinical coding and charges based on provider documentation. 

• Ensure services billed are compliant with applicable rules and regulations, internal policies and procedures, payer requirements and federal guidelines related to professional fee services. 

• Use knowledge of clinical documentation practices, Health Resources and Services Administration (HRSA) and Federally Qualified Health Center (FQHC) methodology. 

• Navigate electronic health records (Evolv and Epic), Work Queues, messaging In-box, etc. 

• Interpret and resolve coding and documentation errors related to denials, charge review and claim edits, and Clearinghouse rejections. 

• This position requires collaborating with staff and programs in the Finance & Business Management Division, Clinical Systems Information (CSI) team, clinical teams, leadership teams, and/or OCHIN, as appropriate. 

• Involves communications with clinical staff, leadership team and internal partners in order to resolve coding and documentation issues. 

• Identify recurring trends, patterns and behaviors that adversely affect timely filing of claims. 

• Identify opportunities for systems and/or workflow improvements.

Professional Direction and Advice

• Attend relevant meetings which may include staff from areas such as Accounts Receivable, Billings, Operations and/or clinical personnel. 

• Coordinate efforts to resolve technical and operational issues that arise. 

• Develop and apply excellent diplomacy, interpersonal and professional skills to work with all levels of the organization to identify, understand, communicate and clearly explain coding errors, trends and concerns, both internally and externally to the organization. 

• Use the equity lens and a trauma-informed approach in listening and providing guidance for understanding, improvement and most advantageous result for staff involved and the Behavioral Health Division.