Coding Specialist 3
UW CODE AND REPRESENTATIVE GROUP
18217 Coding Specialist 2 (NE S SEIU 925 Non Supv)
23539 Coding Specialist 2 (NE H SEIU 925 Non Supv)
BASIC FUNCTION
Review clinical documentation and assign codes supported by patient health records; perform facility or professional fee coding and billing related to surgical or ambulatory procedure charge entry and/or abstract pertinent data from medical records to ensure data integrity and optimal reimbursement.
DISTINGUISHING CHARACTERISTICS
Under general direction, perform coding and/or charge submission of abstract Current Procedural Terminology (CPT) facility or professional fee coding and billing related to surgical or ambulatory procedures. Analyze the medical record to assign International Classification of Diseases (ICD), CPT, Healthcare Common Procedure Coding System (HCPCS) codes and/or modifiers to ensure correct code assignment and optimal reimbursement in compliance with state and federal guidelines.
TYPICAL WORK
Perform chart analysis and assign CPT codes, HCPCS codes, ICD codes and modifiers, as needed, for surgical specialties to ensure the appropriate coding, billing and reimbursement for the medical center;
Reviews available electronic and other appropriate documentation within Epic to identify all billable ambulatory procedures and services for the assigned specialty or service line requiring facility fee coding be captured through Epic ; ensuring all appropriate ICD, CPT and/or HCPCS code(s) and quantities are charged;
Review available electronic and other appropriate documentation to identify all billable components of the surgery, ensuring all necessary codes use the appropriate ICD, CPT, HCPCS codes and/or modifiers. Ensure coded services, charges and clinical documentation meet appropriate guidelines or standards;
Reviews and resolves coding edits related to procedures and services charged during the ambulatory procedure HOD visit at the time of completing coding;
Consults with physicians and/or clinical department representatives, as appropriate, to verify services were rendered, documented, and meets the requirements for coding as an ambulatory procedure;
Maintains three-day coding turnaround times for ambulatory procedure accounts based on date of service;
Identifies and escalates to Coding Leadership impacts to timely coding and charge capture, and avoidable delays for billing and reimbursement;
Consult with physicians and/or clinical department representatives, as appropriate, to verify services rendered and documented. Provide feedback to assist in the understanding of coding and documentation issues and opportunities;
Maintain turnaround times for coding and understand charge lag impact for facility and professional fee services;
Identify the need for documentation clarity to support the integrity of the record and for reimbursement compliance;
Serve as a resource for current surgical coding, billing and regulatory guidelines; including but not limited to review of denials for mitigation and reduction strategies;
May assist in the development and maintenance of the coding manual, standards, and policies and procedures for coding;
May assist with the training of new staff;
May perform special projects;
May perform the work of lower-level classifications of the Coding Specialist series.
Perform related duties, as required.
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
Three years 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.
New Job Class: 05-01-2023, in SEIU 925 Non-Supervisory