Medical Coding Spec II

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

JOB INFORMATION

Effective Date:

12/3/2024

Entity:

Wisconsin

Job Code:

450004

Job Title:

Medical Coding Spec II

Exemption Status:

Non-Exempt

Management Level:

Individual Contributor

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. The incumbent reviews retrospective medical record documentation and ensures that the codes are appropriately assigned. The outcome will be documentation that accurately and completely captures the clinical picture/severity of illness/complexity of the patient while providing specific and complete information to be utilized in coding, profiling and outcomes reporting of both the facility and the physicians.

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, and HCC Coding. 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.

•

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

•

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

•

Participate in training new coding staff, as needed.

•

Collaborates with nursing or coding staff on retrospective medical record review for severity, accuracy, and quality issues.

•

Ensure documentation in the medical record follows the official coding guidelines, internal guidelines and the AHIMA/ACDIS physician query brief.

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

Required

or

In lieu of a medical coding education, an active coding certification

Required

Associate's Degree

in a healthcare related field

Preferred

1 year

of progressive coding experience (For HCC-specific roles, experience must be specific to HCC)

Required

2 years

progressive coding experience in multiple specialties, HCC Risk adjustment Coding

Preferred

Certified Professional Coder (CPC)

Upon Hire

Required

or

Certified Outpatient Coder (COC)

Upon Hire

Required

or

Certified Inpatient Coder (CIC)

Upon Hire

Required

or

Certified Coding Specialist (CCS)

Upon Hire

Required

or

Certified Coding Specialist Physician-Based (CCS-P)

Upon Hire

Required

or

Certified Coding Associate (CCA)

Upon Hire

Required

or

Certified Risk Adjustment Coder (CRC)

Upon Hire

Required

or

Registered Health Information Technician (RHIT)

Upon Hire

Required

or

Registered Health Information Administrator (RHIA)

Upon Hire

Required

Registered Health Information Technician (RHIT)

Preferred

or

Registered Health Information Administrator (RHIA)

Preferred

•

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

•

Extensive knowledge of medical terminology

•

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

•

Extensive 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:

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.