Day Patient Surgery Coder (Facility) Trainer - Auditor (Coding Specialist lll) - Oregon Health & Science University
Portland, OR
About the Job
Department Overview:
This level 3 coding position provides support to the Enterprise Coding Department for the coding of Inpatient services. The Inpatient Coder position requires certification and active credential status with AHIMA and advanced coding experience in the highly specialized areas of Inpatient coding.
- Inpatient Coding Services: This position is responsible for reviewing clinical documentation and assigning the correct ICD 10 CM and ICD 10 PCS coding to Inpatient records.
- Utilizes Epic and 3M 360 systems.
- Effectively communicates via email.
- Collaborates with Coding Leads, Clinical Documentation Specialists and Billing Dept to ensure correct coding and DRG assignment resulting in accurate Case Mix Index calculations and reimbursement.
- Ensures that the documentation is in compliance with ICD 10 and CMS coding guidelines.
- Effectively communicates via email.
- Advises coding partners and new hires in coding assignments.
- Requires maintaining an hourly productivity standard and quality standards as set by Enterprise Coding and based on Industry Standards.
- Requires 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.
Department support:
- Serve as a resource to ERC daypatient coding leadership and coding team for a broad range of audit reviews, training and coder education.
- Develop and disseminate written procedures to facilitate and improve billing and coding processes for the department, and to train, support, 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 coding 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.
- Attends coding meetings and seminars and shares knowledge with other coders. Participates in DP Huddles.
- In collaboration with Enterprise Coding Leadership, develop and disseminate written procedures to facilitate and improve coding, biling and documentation processes.
- Participate in Enterprise Coding education sessions, Kaizen events, maintain CEUs, and stay informed of current coding practices for compliance with federal and/or state laws regarding correct coding set forth by CMS and Oregon Medical Assistance program (OMAP).
Coding
- Coding at 95% or above accuracy
- Facility:
- Daypatient Coding
- Observation services
- Professional:
- Complex Surgical coding
- Integrated Desks (coding both facility and profee services for the same specialty)
- Facility:
- Abstract information from patient medical records to assign correct codes to daypatient records and/or observation cases.Work assigned charge sessions in assigned EPIC charge router work queues.
- Query physicians regarding missing, unclear or conflicting health record documentation by requesting and obtaining additional documentation within the health record when needed.
- 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.
- 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 coding 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 coding denial requests or questions as part of a 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.
- 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.
- 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 CPT
- Certification 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
- Coding certification from AAPC or AHIMA:
- Compliance with Code of Conduct, Respect in the workplace and Applicable policies, procedures and agreements related to position, department or OHSU as a whole
- Must be able to perform the essential functions of the position with or without accommodation
- Accredited Coding Program, Associates or Bachelor Degree; Specialized Coding Credential
- Knowledge of OPPS guidelines and both CPT Inpatient and Outpatient coding guidelines. CCI edits and familiarity with medical necessity guidelines, NCD and LCD requirements.
- Experience using an EMR.
- Some college course work or education in classes related to anatomy/physiology, medical terminology, CPT and ICD-10-CM coding.
- Knowledge of CPT Outpatient coding guidelines. CCI edits and familiarity with medical necessity guidelines.
- Experience using EPIC, 3M encoder.
- 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.
- Ability to work as a team player.
- 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.
Pay Range: $34.43 - $47.27 per hour (Commensurate with qualifications, experience and internal equity)
- Days of work are variable, could include rotating weekend days
- This position is a telecommuting positon
- Department Core hours are: Sunday-Saturday, 5:00am -10:00pm (with some flexibility available).Regularly scheduled work hours are required and are allowed within the Core Hours
Source : Oregon Health & Science University