Job Summary

The Coding Specialist is responsible for providing operational coding support and coordination for one or more business units. This position also assists with coding and billing practices, technical assistance questions, documentation education, and chart auditing to assure compliance with American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS) guidelines relating to coding and billing processes.

Essential Responsibilities

Operational Support

• Responsible for converting healthcare services from medical charts by reviewing and entering medical codes.
• Conduct clinical staff guidance in documentation, coding, and billing to support organizational revenue and operational goals. Provide individual and group education on an ongoing basis.
• Provide coding and billing technical assistance to providers, as needed.
• Collaborate with third party firms for development of coding practices.
• Monitor and maintain regular periodic chart audits; provide follow-up chart education as needed.
• Participate in workgroups and teams to plan and implement new coding and billing initiatives; design and deliver training to clinical groups to support adoption of new services and procedures as needed.
• Provide ongoing chart documentation, coding and billing education to various CareOregon departments and other stakeholders.
• Participate in rate setting initiatives and updates to provider fee-schedules.
• Collaborate with Contracting and other stakeholders to verify adequate and proper payment and coding terms in statements of work and contracts.
• Verify on proper ICD, CPT, and/or HCPC code usage.
• Collaborate with manager to implement operational and organizational initiatives to enhance billing, coding and documentation guidance.
• Coordinate and cross train billing functions and responsibilities.

Organizational Responsibilities

• Perform work in alignment with the organization’s mission, vision and values.
• Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
• Strive to meet annual business goals in support of the organization’s strategic goals.
• Adhere to the organization’s policies, procedures and other relevant compliance needs.
• Perform other duties as needed.

Experience and/or Education

Required

• Minimum 2 years’ experience in evaluation and management services chart auditing within healthcare or behavioral health
• Experience with EHR systems and coding and billing systems
• AAPC or AHIMA certification

Preferred

• Experience leading group educational presentations and teaching to medical professionals

Knowledge, Skills and Abilities Required

Knowledge

• Extensive knowledge of diagnosis and procedure coding conventions as defined by CMS and AMA
• Thorough working knowledge of medical and behavioral health billing practices

Skills and Abilities

• Ability to read and comprehend medical terminology and medical chart notes
• Proficiency working with electronic health record systems
• Strong computer skills, including ability to learn new systems and processes
• Strong working knowledge of Microsoft office products (PowerPoint, Excel, Word)
• Strong written and verbal communication skills
• Ability to effectively teach and coach adult learners
• Ability or organize information in a meaningful way
• Strong attention to detail and problem-solving skills
• Ability to work autonomously and with others, including a high degree of initiative
• Ability to prioritize tasks, problem solve, stay focused and be organized
• Ability to work well under pressure to meet deadlines
• Ability to use good judgment and discretion to perform job responsibilities
• Ability to adhere to organizational standards, policies and procedures

• Ability to work effectively with diverse individuals and groups

• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, hear, speak clearly and perform repetitive finger and wrist movement for at least 6 hours/day

Working Conditions

Work Environment(s): Indoor/Office Community Facilities/Security Outdoor Exposure

Member/Patient Facing: No Telephonic In Person

Hazards: May include, but not limited to, physical and ergonomic hazards.

Equipment: General office equipment

Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment

Veterans are strongly encouraged to apply.

Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.