Role Description We are seeking a detail-oriented and knowledgeable Medical Biller and Coder for Urgent Care and ER to join our healthcare team. The ideal candidate will be responsible for managing the billing process, ensuring accuracy in medical coding, and facilitating timely payments from insurance companies and patients. A strong understanding of medical terminology, coding systems, and collections is essential for success in this role. - Process medical billing claims accurately and efficiently using appropriate coding systems such as ICD-10 and ICD-9. - Review patient records to ensure all necessary information is included for billing purposes. - Verify insurance coverage and benefits prior to submitting claims to ensure proper reimbursement. - Follow up on unpaid claims and conduct medical collections as necessary. - Maintain accurate records of all billing transactions and communications with insurance companies and patients. - Collaborate with healthcare providers to resolve any discrepancies in billing or coding. - Stay updated on changes in medical billing regulations, coding practices, and insurance policies. - Utilize medical office systems effectively to manage billing processes and maintain patient confidentiality. Qualifications - Proven experience in medical billing, coding, or a related field is preferred. - Strong knowledge of medical terminology, DRG (Diagnosis Related Group), and various coding systems (ICD-10, ICD-9). - Familiarity with medical records management and the healthcare reimbursement process. - Excellent attention to detail with strong organizational skills. - Ability to communicate effectively with healthcare professionals, insurance representatives, and patients. - Proficient in using medical office software and billing systems. - Certification in medical billing or coding is a plus but not required. Requirements - ICD-10: 1 year (Required) Benefits - Dental insurance - Health insurance - Paid time off - Vision insurance

• Support our life-saving Lifeline products by using your medical billing and collecting experience to obtain maximum reimbursement while establishing strong relationships with insurance companies and customers. • Obtaining and entering Medicaid authorizations accurately and timely to ensure clean claims are released • Reviewing claims for the accuracy of procedures, diagnoses, demographic and insurance information • Obtaining and entering equipment upgrades and correspondence from the payer agencies • Reviewing and correcting all claims/charge denials and edits that are communicated via Explanation of Benefits (EOB) and other methods of communication • Monitoring days in Accounts Receivable and ensuring that they are maintained at the levels expected by management • Communicating proactively of any billing issues identified • Timely follow-up on billing and claims discrepancies as communicated by the payer. • Reading and interpreting insurance Explanation of Benefits • Responding to inquiries from agencies, case managers, insurance companies, and internal customers in a timely manner • Regularly attending monthly staff meetings and in-house training events • Additional duties and responsibilities as required and or assigned.

Role Description This level 3 coding position provides support to the Enterprise Coding Department for coding highly specialized services. This position requires advanced coding experience in highly specialized areas of coding and certification with AAPC or AHIMA. - Coding at 95% or above accuracy. - Abstract information from patient medical records to assign correct codes and charges to outpatient surgical records and/or observation cases. - Work assigned charge sessions in assigned EPIC charge router work queues. - Assign correct CPT, ICD-10-CM, HCPCS, or ICD-10-PCS and DRGs for facility and/or professional charges. - 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 billing 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 with billing any issues, coding denial requests, or questions as part of the 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. - 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. - Serve as a resource to ERC outpatient coding leadership and coding team for a broad range of billing policy and procedure issues. - Monitor coding and billing information from CMS guidelines, professional licensing organizations, internal communication memos, and transmittals from coding publishers and governmental agencies. - Make recommendations to coding leadership and implement remedial actions for problems. - Attend coding meetings and seminars and share knowledge with other coders. - Participate in EC Huddles. - Collaborate with Enterprise Coding Leadership to develop and disseminate written procedures to facilitate and improve billing and documentation processes. - Other duties as assigned. Qualifications - High school diploma or GED. - Minimum of 4 years professional or hospital experience reviewing, abstracting, coding in ICD 10 CM or ICD 10 PCS, or CPT. - Certification in one of the following Coding certifications 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) - Certified Professional Coder (CPC) through the American Academy of Professional Coders - Active AAPC membership is required. Preferred Qualifications - Accredited Coding Program, Associates or Bachelor Degree; Specialized Coding Credential. - Knowledge of OPPS guidelines and both CPT Inpatient and Outpatient coding guidelines. - 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. - 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. - 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. Benefits - Healthcare for full-time employees covered 100% and 88% for dependents. - $50K of term life insurance provided at no cost to the employee. - Two separate above market pension plans to choose from. - Vacation - up to 200 hours per year dependent on length of service. - Sick Leave - up to 96 hours per year. - 9 paid holidays per year. - Substantial Tri-Met and C-Tran discounts. - Employee Assistance Program. - Childcare service discounts. - Tuition reimbursement. - Employee discounts to local and major businesses.

• Utilize available encoder, grouper software, and other coding resources to determine the appropriate ICD-10-CM, CPT, and/or HCPCS including specialty specific codes and Evaluation and Management (E&M) codes • Maintain an understanding and apply knowledge of National Correct Coding Initiatives (NCCI), Local Coverage Documents and National Coverage Documents (LCD/NCD) directives, Medically Unlikely Edits (MUEs), and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory requirements and institutional guidelines to select appropriate codes and modifiers