ED Coder (Coding Specialist III)

Department Overview

This level 3 coding positions provides support to the Enterprise Coding Department for coding highly

specialized services. This position covers requires advanced coding experience in highly specialized areas of

coding, 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 ED, Interventional Radiology, Neurosurgery, Orthopedics, Trauma, Critical care 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.

Function/Duties of Position

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
    • ED Coding
    • Neurosurgery Coding
    • Orthopedics Coding
    • Critical care
    • Trauma
    • 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 staf