Daypatient Surgery GI Coder (Coding Specialist 3)

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.

Function/Duties of Position

Coding

• Coding at 95% or above accuracy.
• Abstract information from patient medical records to assign correct codes and charges to outpatient surgical records, and/or observation cases. Work assigned charge sessions in assigned EPIC charge router work queues.
• Depending on 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).
• 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.
• Develop and disseminate written procedures to facilitate and improve billing and coding processes for the department, and to train, support and mentor and orientate coding staff as necessary.
• Monitor coding and billing information from CMS guidelines, Professional licensing organizations, Internal communication memos, and transmittals from coding publishers and governmental agencies to advise facility and team of billing practice changes in CPT, ICD-10-CM, and HCPCS and ensure changes are implemented to maximize revenue and reflect medical evaluation of patient encounters.
• Make recommendations to coding leadership and implement remedial actions for problems. 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.
• 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.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.

Other duties as assigned.

Required Qualifications

• High school diploma or GED.
• Minimum of 4 years professional or hospital experience reviewing, abstracting, coding in ICD 10 CM or ICD 10 PCS, or CPT.
• Certification in one of the following 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 AAPC membership is required.