BizTek People
Job description:
This position provides support to the Department for billing of physician’s fees (Medicare Part B) and Facility fees (Medicare Part A). This position is responsible for reviewing documentation to make sure the documentation supports the levels or types of service billed and/or assign level of service based on documentation. Ensure the documentation is in compliance with Medicare/Medicaid billing regulations and documentation guidelines, CPT documentation guidelines, and PATH rules. Responsible for meeting performance standards set for accurate and timely submission of charges for professional and facility services rendered. Provide technical expertise regarding a broad range of third party payer and reimbursement issues. Potential to provide physician education on billing and coding practices and advise physicians of coding changes or changes in regulations. Coding assignment will vary based on assignment and need. Focus on Anesthesia Pro fee billing.
Key Responsibilities & Performance Standards
Billing review: Review documentation of services in EPIC, paper charts, and any other source of documentation available to ensure compliance with the Centers for Medicare and Medicaid Services (CMS) regulations and assign correct CPT, ICD-10-CM, and HCPCS codes. Enter billing information in applicable system (EPIC, Ebridge) ensuring 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. Reconcile and research available schedules and databases to ensure complete charge capture.
Compliance support: Resolve with providers any issues or questions which are found prior to submission for processing. Serve as a resource to providers for billing policy and procedure issues. Monitor coding and billing information from newsletters, memos, and transmittals from coding publishers and governmental agencies to advise co-workers of billing practice changes in CPT, ICD-10-CM, and HCPCS and insure changes are implements to maximize revenue.
Billing and Collection support: Act as a resource for centralized university billing group and outsourced billing agent regarding coding and billing questions.
Act as backup for APOM Clinical Documentation Specialist and Leadworker for Pain and ICU coding.
Other Duties as assigned
Additional competencies listed below apply to employees in a leadership position.
Systems Thinking: Ability to see and understand whole systems and how elements within systems relate. Works cooperatively with others to use appropriate systems strengths, knowledge and cooperation to improve performance.
Managing Resources: Meets performance goals and budget targets. Effectively manages departmental resources. Understands financial systems and uses them effectively. Demonstrates the financial acumen for managing budgets aggressively. Effectively manages vendor relationships to maximize contributions.
Change Leader: Ability to act and provide leadership throughout the change process. Engages employees in the entire process and develops commitment for sustaining change.
Developing Organizational Talent: Ability to recruit, retain and develop high performing individuals aligned with goals and values. Completes performance reviews and development plans for all direct reports on time.
Requirements Qualifications:
Education: High school diploma or GED - Mandatory
Preferred: Accredited Coding Program Training and Associates degree in applicable field.
Required: Four years of hospital or professional services (dependent on job) experience reviewing,
abstracting, and coding medical records using ICD-10-CM and CPT coding; OR
Completion of Medical Records Coding course through an accredited college or
university OR An equivalent combination of experience and training.
Preferred: Two years experience coding professional (Medicare Part B) services of physicians
Job Related Knowledge, Skills and Abilities (Competencies):
Knowledge of CPT, ICD-10-CM, HCPCS, Federal Register, Federal and State insurance billing laws and Mandates.
Required: Formal Medical Terminology (either prior to or upon employment).
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 in a close proximity environment.
Preferred:
Some college course work or education in classes related to anatomy/physiology, CPT and ICD-10-CM coding.
Two years experience coding the professional (Medicare Part B) services of physicians.
Registrations, Certifications and/or Licenses:
Required:
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
Preferred:
Certified Professional Coder (CPC)
Compliance: Code of conduct, Respect in the workplace
Applicable policies, procedures and agreements related to position, department or OHSU as a whole Not applicable
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This position provides support to the Department for billing of physician’s fees (Medicare Part B) and Facility fees (Medicare Part A). This position is responsible for reviewing documentation to make sure the documentation supports the levels or types of service billed and/or assign level of service based on documentation. Ensure the documentation is in compliance with Medicare/Medicaid billing regulations and documentation guidelines, CPT documentation guidelines, and PATH rules. Responsible for meeting performance standards set for accurate and timely submission of charges for professional and facility services rendered. Provide technical expertise regarding a broad range of third party payer and reimbursement issues. Potential to provide physician education on billing and coding practices and advise physicians of coding changes or changes in regulations. Coding assignment will vary based on assignment and need. Focus on Anesthesia Pro fee billing.
Key Responsibilities & Performance Standards
Billing review: Review documentation of services in EPIC, paper charts, and any other source of documentation available to ensure compliance with the Centers for Medicare and Medicaid Services (CMS) regulations and assign correct CPT, ICD-10-CM, and HCPCS codes. Enter billing information in applicable system (EPIC, Ebridge) ensuring 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. Reconcile and research available schedules and databases to ensure complete charge capture.
Compliance support: Resolve with providers any issues or questions which are found prior to submission for processing. Serve as a resource to providers for billing policy and procedure issues. Monitor coding and billing information from newsletters, memos, and transmittals from coding publishers and governmental agencies to advise co-workers of billing practice changes in CPT, ICD-10-CM, and HCPCS and insure changes are implements to maximize revenue.
Billing and Collection support: Act as a resource for centralized university billing group and outsourced billing agent regarding coding and billing questions.
Act as backup for APOM Clinical Documentation Specialist and Leadworker for Pain and ICU coding.
Other Duties as assigned
Additional competencies listed below apply to employees in a leadership position.
Systems Thinking: Ability to see and understand whole systems and how elements within systems relate. Works cooperatively with others to use appropriate systems strengths, knowledge and cooperation to improve performance.
Managing Resources: Meets performance goals and budget targets. Effectively manages departmental resources. Understands financial systems and uses them effectively. Demonstrates the financial acumen for managing budgets aggressively. Effectively manages vendor relationships to maximize contributions.
Change Leader: Ability to act and provide leadership throughout the change process. Engages employees in the entire process and develops commitment for sustaining change.
Developing Organizational Talent: Ability to recruit, retain and develop high performing individuals aligned with goals and values. Completes performance reviews and development plans for all direct reports on time.
Requirements Qualifications:
Education: High school diploma or GED - Mandatory
Preferred: Accredited Coding Program Training and Associates degree in applicable field.
Required: Four years of hospital or professional services (dependent on job) experience reviewing,
abstracting, and coding medical records using ICD-10-CM and CPT coding; OR
Completion of Medical Records Coding course through an accredited college or
university OR An equivalent combination of experience and training.
Preferred: Two years experience coding professional (Medicare Part B) services of physicians
Job Related Knowledge, Skills and Abilities (Competencies):
Knowledge of CPT, ICD-10-CM, HCPCS, Federal Register, Federal and State insurance billing laws and Mandates.
Required: Formal Medical Terminology (either prior to or upon employment).
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 in a close proximity environment.
Preferred:
Some college course work or education in classes related to anatomy/physiology, CPT and ICD-10-CM coding.
Two years experience coding the professional (Medicare Part B) services of physicians.
Registrations, Certifications and/or Licenses:
Required:
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
Preferred:
Certified Professional Coder (CPC)
Compliance: Code of conduct, Respect in the workplace
Applicable policies, procedures and agreements related to position, department or OHSU as a whole Not applicable
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