NI-Medical Coding Specialist II

J  o  b    D  e  s  c  r  i  p  t  i  o  n

JOB INFORMATION

Effective Date:

5/23/2024

Entity:

Illinois

Job Code:

NI-3380CL

Job Title:

NI-Medical Coding Specialist II

Exemption Status:

Non-Exempt

JOB SUMMARY

In accordance with both Official and UW Health Coding Guidelines, the Medical Coding Specialist II determines the appropriate ICD-10-CM, CPT, CDT, and HCPCS, or HCC codes for providers and facility services based on clinical documentation. This position may include coding multiple (sub)specialties, professional component coding of inpatient facility, outpatient facility, non-facility and/or professional fee agreements and/or the facility/technical component. This position may also include some charge entry for outreach billing. The incumbent may also be responsible for provider and staff education.

MAJOR RESPONSIBILITIES

•

Review information available in the electronic medical record and/or paper record to accurately code the episode of care in multiple specialty areas, including inpatient and outpatient settings.

•

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.

•

Actively participate in and maintain coding quality and productivity processes.

•

Communicate directly with physician and non-physician providers to resolve conflicting provider documentation to establish cause and effect relationships between conditions and further specify diagnoses and procedures documented within the medical record.

•

Provide ongoing feedback to physicians and other providers regarding coding guidelines and requirements. Assist with educational in-services for physicians, other providers, and clinic staff relating to documentation compliance as well as new policies and procedures related to billing.

•

Participate in training new coding staff, as needed.

•

Navigate software workflows and processes to identify and resolve appropriate electronic rules and create efficiencies.

•

Resolve payer denials and respond to inquiries from revenue cycle teams, processing charge corrections as appropriate.

•

HCC Specific responsibilities:
o Reviews documentation to identify ICD-10-CM diagnoses, that map to a Risk Adjusted HCC ensuring the documentation meets all CMS standard requirements for valid HCC Submission
o Participates effectively in Clinical

ALL DUTIES AND REQUIREMENTS MUST BE PERFORMED CONSISTENT WITH THE UW HEALTH PERFORMANCE STANDARDS.

X

Non-Clinical

JOB REQUIREMENTS

High School diploma or equivalent and medical coding education. In lieu of a medical coding education, an active coding certification is required.

Required

Associate degree in a healthcare related field.

Preferred

Two years progressive coding experience in multiple specialties, HCC Risk adjustment Coding.

Preferred

Minimum of one-year of progressive coding experience.

Required

Experience with coding concepts (Current Procedural Terminology (CPT), International Classification of Disease 10th Edition-Clinical Modification (ICD-10-CM), Code on Dental Procedures and Nomenclature (CDT), Health Care Procedure Coding System (HCPCS), Diagnosis Related Group (DRG), and Hierarchical Condition Categories (HCC) for HCC.

Required

Experience using Microsoft Office (i.e., Excel, Word).

Required

Certification as Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC), Certified Coding Specialist (CCS), or Certified Coding Specialist Physician-Based (CCS-P), or a Certified Coding Associate (CCA) required, Certified Risk Adjustment Coder (CRC), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA) required within one year of hire for HCC.

Required

Registered Health Information Technician (RHIT).

Preferred

Registered Health Information Administrator (RHIA).

Preferred

•

Extensive knowledge of medical terminology.

•

Extensive knowledge of Anatomy and Physiology.

•

Effective communication skills, written and oral.

•

Demonstrated capacity to work independently and in a team environment.

PHYSICAL REQUIREMENTS/WORKING CONDITIONS

Standing

X

Walking

X

Climbing

X

Bending

X

Crouching

X

Pushing / Pulling

X

Carry

X

Fine Hand / Eye Coordination

X

Color Discrimination

X

Hearing Ability

X

Lifting / Lowering 1 -15 lbs.

X

15 - 30 lbs.

X

30 - 50 lbs.

X

Over 50 lbs.

UW Health does not require, nor does it expect that its employees lift more than 50 lbs unassisted. Objects in excess of 50 lbs should be lifted or moved with mechanical means or through a team lift. Employees in patient care areas are expected to utilize mechanical lifts and adhere to the "Use of Mechanical Lifts (Liko)" policy in the Patient Services Policy and Procedure Manual.

Concentration on Detail

X

Attention Span of 1 + Hours on a Task

X

Ability to Remember Multiple Tasks

X

Oral Communication

X

Written Communication

X

Exposure to Blood and Body Fluids

X

Exposure to Toxins, Cytotoxins, Poisons

X

Exposure to Extreme Heat, Cold, Temp Fluctuations

X

Exposure to Hazardous Chemicals

X

Exposure to Radiation

X

Note: The purpose of this document is to describe the general nature and level of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.