One Community Health
Under 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 at 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 (OCH). Provide accurate and timely medical, dental and/or behavioral health coding for three 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. Works in partnership and joint accountability with other team members to achieve OCH’s Mission, Values, Service Commitments and Goals.
- Embrace the philosophy, mission, and values of OCH.
- Adhere to the guidelines and procedures of OCH.
- Active 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.
- Through 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
- Assist all staff with coding queries; serves as domain expert of coding guidelines and code assignment
- Maintain 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
- Maintain a Clinical Documentation Dashboard by adding the information from the Excel spreadsheet for each provider into the Dashboard each month
- Maintain and update OB Spreadsheet (current list of perinatal patients seen at OCH)
- Print 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.
- Set up new accounts for hospital billing.
- Transfer quarterly Provider Audit Results conducted by RMC (contractor) to the Provider’s Individual Reports folder
- Work 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
- Review 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
- Process all charges within four days of provider release
- Work closely with contracted coding services (RMC) staff to recognize documentation/coding issues and implement improvements
- Notify Coding Services Manager and Revenue Cycle Manager of any coding trends, inaccuracies or workflow issue
- Attend meetings as needed.
- Maintain current Coding Certification by acquiring required CEUs through AAPC or AHIMA
- Where providers have made errors or missed coding, use as educational tool for the provider(s)
- Assist in educating providers and staff in requirements of documentation for proper reimbursement
- Assists all staff with coding as required, makes final determination of code assignment as the coding domain expert
- Constant review and recommends updates on coding change
- Applies appropriate adjustments to charges including sliding scale discounts and third-party contractual adjustments.
- Corrects mistakes in patient accounts including checking for insurance eligibility and billing to insurance companies, if necessary.
- Determine problem that resulted in a rejected claim, resolve, advise on procedural changes to implement and prevent further such rejects.
- Resubmit/refile and appeal rejected claims, as is necessary.
- Adhere to contractual requirements of Medicare, Medicaid, and managed care plans
- Scrub and submit claims
KNOWLEDGE, SKILLS, AND ABILITIES
- Strong attention to detail.
- Working knowledge of Commercial, TPL, and Government payer guidelines.
- Knowledge of collection polices and guidelines including knowledge of CPT, HCPCS and ICD-10 code systems
- Knowledge of Medical terminology
- Able to process multi-line telephone calls.
- Able to work in a fast-paced environment
- Able to prioritize and organize work according to multiple and, at times, competing timelines
- Able to meet timelines for team and organizational goals safely and with high level of quality.
- Successful relationship management skills involving multidisciplinary teams in a diverse, multicultural environment.
- Able to use initiative and good judgment to resolve problems and challenges
- Able to work effectively in an operation that expects and promotes teamwork and have demonstrated ability to work with ambiguity.
- Able to inspire trust and confidence, and communicate effectively and respectfully with internal and external audiences
- Able to work independently, work with multiple projects and maintain a high degree of professionalism and confidentiality.
- High level computer skills, including use of Microsoft Office applications: Word, Excel, Outlook, EHR, and other systems
- Knowledge of and compliance with HIPAA regulations
- Knowledge of workplace safety
- Able to work in a team environment, to work independently, and/or be self-directed
- Identify 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 7 years healthcare coding experience in a primary care setting or FQHC
- Minimum 2 years EHR experience
- Knowledge of procedures, workflows, and data flow in a health care organization
- Associates 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
- Outpatient and Professional Coding experience
- Behavioral health coding experience
- Experience coding in a Federally Qualified Health Center (FQHC)
- Understand and work with HRSA requirements and expectations
- Epic EHR experience
- Internal locus of control
- Expectation to excel and be part of a high functioning team
- Understand and work within a systems perspective
- 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
One of the following:
- Certified Coding Specialist Physician Based (CCS-P) – valid American Health Information Management Association (AHIMA) certification
- Certified Coding Specialist (CCS) – American Health Information Management Association (AHIMA) certification
- Certified Professional Coder (CPC) – valid American Academy for Professional Coders (AAPC) certification
We have a generous benefits package which included medical, dental & vision coverage. Company-paid long-term disability. This includes a 401k plan with company match. Up to 200 hours of paid time off per year and 6 Paid holidays for full-time staff.
Instructions for Resume Submission:
To apply and submit resume visit One Community Health website: https://www.onecommunityhealth.org/careers/