University of Washington Human Resources

UW CODE AND REPRESENTATIVE GROUP

18213 Coding Specialist 2 (NE S SEIU 925 Non Supv)
21213 Coding Specialist 2 (NE H SEIU 925 Non Supv)

BASIC FUNCTION

Under general direction, perform coding and/or charge submission of abstract Diagnosis Related Group (DRG) or abstract Current Procedural Terminology (CPT) professional fee and facility coding and billing. Analyze the medical record to assign International Classification of Diseases (ICD), CPT and/or 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.

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 ICD codes and compute the final DRG assignment to diagnoses and procedures in an integrated system to ensure the appropriate coding, billing and reimbursement for the facility;

Review patient records upon admission and at discharge to the Rehabilitation Unit; assign codes to each record to assure proper Case Mix Group (CMG) assignment and appropriate reimbursement to the facility for Medicare Rehab patients;

Review available electronic and other appropriate documentation to identify all billable procedures and services requiring facility and/or professional fee coding, ensuring all necessary codes use the appropriate ICD, CPT and/or HCPCS code. Ensure coded services, charges and clinical documentation meet appropriate guidelines or standards;

Abstract and/or review necessary patient data to ensure data integrity, accurate reimbursement, proper case mix and hospital decision support;

Work with the Clinical Documentation Improvement (CDI) department to review clinical documentation and/or request provider documentation clarifications;

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 coding, billing and regulatory guidelines;

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;

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

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. As of 05-01-2023 renamed from Coding Specialist 3 to Coding Specialist 4 and revised basic functions and distinguishing characteristics.