Medical Coding Spec I

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

JOB INFORMATION

Effective Date:

7/25/2024

Entity:

Wisconsin

Job Code:

450002

Job Title:

Medical Coding Spec I

FLSA Exemption Status:

Non-Exempt

Management Level:

Individual Contributor

JOB SUMMARY

In accordance with both Official and UW Health Coding Guidelines, the Medical Coding Specialist I determines the appropriate ICD-10-CM, CPT, CDT, and HCPCS codes for providers and facility services based on clinical documentation. This position may include 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.

ESSENTIAL DUTIES

•

Review information available in the electronic medical record and/or paper record to accurately code the episode of care.

•

Utilize available encoder, grouper software and other coding resources to determine the appropriate ICD-10-CM, CPT, and/or HCPCS including 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 a cause and effect relationships between conditions and further specify diagnoses and procedures documented within the medical record.

•

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

•

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

As needed, additional responsibilities reasonably within the scope of duties and physical requirements may be assigned.  ALL DUTIES AND REQUIREMENTS MUST BE PERFORMED CONSISTENT WITH THE UW HEALTH PERFORMANCE STANDARDS AND RESPECT FOR PEOPLE COMMITTMENTS.

X

Non-Clinical

JOB REQUIREMENTS

High School Diploma

or equivalent and a graduate of or currently enrolled in a Medical Coding Program. In lieu of a Medical Coding education, an active coding certification is required.

Required

Associate's Degree

in a healthcare related field

Preferred

1 year

of progressive coding experience

Preferred

Certified Professional Coder Apprentice (CPC-A)

within 1 Year

Required

or

Certified Professional Coder (CPC)

within 1 Year

Required

or

Certified Outpatient Coder Apprentice (COC-A)

within 1 Year

Required

or

Certified Outpatient Coder (COC)

within 1 Year

Required

or

Certified Inpatient Coder (CIPC)

within 1 Year

Required

or

Certified Coding Specialist (CCS)

within 1 Year

Required

or

Certified Coding Specialist Physician-Based (CCS-P)

within 1 Year

Required

or

Certified Coding Associate (CCA)

within 1 Year

Required

LICENSE, CERTIFICATIONS, AND REGISTRATIONS MUST BE MAINTAINED PER UW HEALTH POLICY. 

•

Knowledge of coding concepts (Current Procedural Terminology (CPT), International Classification of Disease 10th Edition-Clinical Modification (ICD-10), Code on Dental Procedures and Nomenclature (CDT), and Health Care Procedure Coding System (HCPCS))

•

Knowledge of medical terminology

•

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

•

Knowledge of Anatomy and Physiology

•

Demonstrated capacity to work independently and in a team environment

•

Effective communication skills, written and oral

PHYSICAL REQUIREMENTS/WORKING CONDITIONS

☒

Sedentary: Ability to lift up to 10 pounds maximum and occasionally lifting and/or carrying such articles as dockets, ledgers and small tools. Although a sedentary job is defined as one, which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Up to 10#

Negligible

Negligible

☐

Light: Ability to lift up to 20 pounds maximum with frequent lifting and/or carrying of objects weighing up to 10 pounds. Even though the weight lifted may only be negligible amount, a job is in this category when it requires walking or standing to a significant degree.

up to 20#

Up to 10# or requires significant walking or standing or requires pushing/pulling of arm/leg controls.

Negligible or constant push/pull of items of negligible weight

☐

Medium: Ability to lift up to 50 pounds maximum with frequent lifting and/or carrying objects weighing up to 25 pounds.

20-50#

10-25#

Negligible-10#

☐

Heavy: Ability to lift up to 100 pounds maximum with frequent lifting and/or carrying objects weighing up to 50 pounds.

50-100#

25-50#

10-20#

☐

Very Heavy: Ability to lift over 100 pounds with frequent lifting and/or carrying objects weighing over 50 pounds.

Over 100#

Over 50#

Over 20#

Other - list any other physical requirements or bona fide occupational qualifications not indicated above:

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.

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.

THE EMPLOYEE MUST BE ABLE TO COMPLETE ALL PHYSICAL REQUIREMENTS OF THE JOB WITH OR WITHOUT AN APPROVED ACCOMODATION. 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.