the direct management of the Coding Services Manager, the Coding Specialist is
responsible for on-site routine and complex encounter coding validation and
code assignment for One Community Health, a Federally Qualified Health Center (FQHC). Ensure appropriate coding of services and diagnosis based on
review of the clinical documentation in the medical record for One Community
Health. Provide accurate and timely medical, dental and/or behavioral health
coding for One Community Health's health centers and programs. Adheres to
official coding guidelines to maintain OCH compliance with CMS fraud, waste
& abuse regulations and requirements. Works collaboratively with Billing
Services and within the Revenue Cycle. Work in partnership and joint
accountability with other team members to achieve One Community Health’s
Mission, Values, Service Commitments and Goals.
Embrace the philosophy, mission,
and values of OCH.
Adhere to the guidelines and
procedures of OCH.
participation as a member of the billing team in assisting others as needed to
ensure all daily activities are completed, company goals are achieved, and
continuous improvements and cost efficiencies are identified and pursued.
direct efforts and coordination of others’ efforts,
ensure timely and accurate processing of claims in a manner that is compliant
with industry standards and regulations and company policy and procedure.
Consistently seek improvement in
policies and procedures for all billing and reimbursement functions to ensure
department activities are carried out professionally and ethically, patients
are treated respectfully, and revenue is optimized.
Maintains third party information
in the practice management system.
Set up new accounts
Answer coding and billing
questions in a timely manner.
Apply all CMS official coding
guidelines and regulatory requirements for assignment of ICD-10, CPT, and HCPCS
codes including adding modifiers when appropriate
all staff with coding queries; serves as domain expert of coding guidelines and
an Excel spreadsheet documenting all corrections and additions (ICD diagnosis,
CPT level of service & procedure or HCPCS and modifiers) made by coding
specialists each month
a Clinical Documentation Dashboard by adding the information from the Excel
spreadsheet for each provider into the Dashboard each month
and update OB Spreadsheet (current list of perinatal patients seen at OCH)
out and code all Newborns and OB deliveries performed by OCH providers at
Providence Hood River Medical Hospital. Create encounters and post/bill out
deliveries and newborns seen by OCH providers weekly.
up new accounts for hospital billing.
quarterly Provider Audit Results conducted by RMC (contractor) to the
Provider’s Individual Reports folder
with other members of the Revenue Cycle team to configure accounts, resolve
denials, conduct coding reviews, and correct claims. Maintain excellent
customer service, safeguarding confidentiality of sensitive patient and
financial information at all times
encounter documentation in support of all diagnoses, procedures, and
professional services that were pre-selected by the clinic. Verify the accuracy
of all charges and add missing charges as appropriate. Identify documentation
and coding errors and work with providers and clinical staff to obtain proper
coding and documentation
all charges within four days of provider release
closely with contracted coding services (RMC) staff to recognize
documentation/coding issues and implement improvements
Coding Services Manager and Revenue Cycle Manager of any coding trends,
inaccuracies or workflow issue
meetings as needed.
current Coding Certification by acquiring required CEUs through AAPC or AHIMA
providers have made errors or missed coding, use as educational tool for the
in educating providers and staff in requirements of documentation for proper
all staff with coding as required, makes final determination of code assignment
as the coding domain expert
review and recommends updates on coding change
appropriate adjustments to charges including sliding scale discounts and third-party
mistakes in patient accounts including checking for insurance eligibility and
billing to insurance companies, if necessary.
problem that resulted in a rejected claim, resolve, advise on procedural changes
to implement and prevent further such rejects.
and appeal rejected claims, as is necessary.
to contractual requirements of Medicare, Medicaid, and managed care plans
and submit claims
attention to detail.
knowledge of Commercial, TPL, and Government payer guidelines.
of collection polices and guidelines including knowledge of CPT, HCPCS and
ICD-10 code systems
of Medical terminology
to process multi-line telephone calls.
to work in a fast-paced environment
to prioritize and organize work according to multiple and, at times, competing
to meet timelines for team and organizational goals safely and with high level
relationship management skills involving multidisciplinary teams in a diverse,
to use initiative and good judgment to resolve problems and challenges
to work effectively in an operation that expects and promotes teamwork and have
demonstrated ability to work with ambiguity.
to inspire trust and confidence, and communicate effectively and respectfully
with internal and external audiences
to work independently, work with multiple projects and maintain a high degree
of professionalism and confidentiality.
level computer skills, including use of Microsoft Office applications: Word,
Excel, Outlook, EHR, and other systems
of and compliance with HIPAA regulations
of workplace safety
to work in a team environment, to work independently, and/or be self-directed
learning needs and goals and design a plan to meet them.
- Able and willing to work
in a dynamic and changing community health care environment
MINIMUM REQUIRED QUALIFICATIONS
· High School Diploma or GED equivalent. Graduate of
an AHIMA Accredited Health Information Technology program or certification in a
self-study course from AHIMA or AAPC
Passed medical terminology, and anatomy and physiology
courses or demonstrated ability
of the following:
1) Certified Coding Specialist Physician Based (CCS-P)
– valid American Health Information Management Association (AHIMA)
2) Certified Coding Specialist (CCS) – American Health
Information Management Association (AHIMA) certification
Certified Professional Coder (CPC) – valid American
Academy for Professional Coders (AAPC) certification
7 years healthcare coding experience in a primary care setting or FQHC
2 years EHR experience
of procedures, workflows, and data flow in a health care organizationPreferred Qualifications
Degree with Active Credentials as a Registered Health Information Technician
(RHIT) or Bachelor’s Degree with Active Credentials as a Registered Health
Information Administrator (RHIA) or Associate degree in medical billing field
and Professional Coding experience
health coding experience
coding in a Federally Qualified Health Center (FQHC)
and work with HRSA requirements and expectations
locus of control
to excel and be part of a high functioning team
and work within a systems perspective