Coding Specialist 1
UW CODE AND REPRESENTATIVE GROUP
18211 Coding Specialist 1 (NE S SEIU 925 Non Supv)
21211 Coding Specialist 1 (NE H SEIU 925 Non Supv)
BASIC FUNCTION
Participate in the review of clinical documentation and validate codes supported by patient health records; provide charge entry support and/or abstract pertinent data from medical records to assist with data integrity and optimal reimbursement.
DISTINGUISHING CHARACTERISTICS
Under general supervision, analyze medical records to validate the correct coding assignment of International Classification of Disease (ICD), Current Procedural Terminology (CPT) and/or Healthcare Common Procedure Coding System (HCPCS) codes in Epic clinic work queues and/or Hierarchical Condition Category (HCC) / Risk Adjustment Factor (RAF) and/or Care Gap review to ensure optimal reimbursement for facility and/or professional fee coding and billing for Clinic and related charges needing coding review in compliance with state and federal guidelines.
TYPICAL WORK
Validate codes entered at the point of care and/or by other charge sources by reviewing electronic data and making corrections based on a review of all available electronic and other appropriate documentation to support all billable procedures and services requiring Clinic coding;
Review and resolve Clinic specific coding edits, claim edits and denials in Epic:
Maintain turnaround times for coding reviews and understand charge lag impact for facility and professional fee services;
Identify potentially avoidable delays for reimbursement and help identify systemic issues that contribute to delays in service or inefficient uses of resources to address root cause and prevent ongoing errors;
Identify the need for documentation clarity to support the integrity of the record and for reimbursement compliance;
Serve as a resource for current coding, billing and regulatory guidelines;
Investigate and research billing and coding issues as related to inquiries, complaints or audit results, as requested;
May assist with training of new staff;
May perform special projects;
Perform related duties, as required;
May perform the work of lower level classifications of the Coding Specialist series.
MINIMUM QUALIFICATIONS
High school diploma or equivalent
AND
Certified as a Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Certified Coding Specialist – Physician Based (CCS-P), Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), Certified Outpatient Coder (COC), Certified Interventional Radiology Cardiovascular Coder (CIRCC), Radiology Certified Coder (RCC) or Radiation Oncology Certified Coder (ROCC).
AND
One year coding experience or equivalent education/experience.
CLASS SPECIFICATION HISTORY
New Classification: Coding Specialist series effective 09-01-2017 as agreed to with SEIU 925. New series incorporates the work previously performed in the Clinical Data Specialist series.
Revised basic function and distinguishing characteristics: 05-01-2023