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Medical Coding Specialist
Western Wisconsin Health

Location: Baldwin, Wisconsin
Work Setting: Hospital
Job Function:
Coder
Job Type:
Full-Time

Introduction

MEDICAL CODING SPECIALIST

Western Wisconsin Health is looking for a full-time Medical Coding Specialist (1.0 FTE) to join the Health Information Management department. The Medical Coding Specialist is responsible for reviewing clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10-CM and CPT-4 codes for billing, internal and external reporting, research, and regulatory compliance. Under the direction of the HIM Director, accurately code inpatient, observation, outpatient diagnostic, therapeutic, consultative, emergency department services, ambulatory surgery (same day surgery), and clinic encounters, as assigned. Obtain appropriate reimbursement levels for professional services by reviewing and coding clinical diagnoses and procedures for physician visits and other services, conditions and procedures as documented in the ICD-10-CM and Official Guidelines for Coding and Reporting and CPT Coding Guidelines. Resolve errors associated with billing software edits, identify and report error patterns, and assist in design and implementation of workflow changes to reduce billing errors and improve coding efficiencies as appropriate for area of coding responsibility. Analyze denial and rejection reports and appeals whenever appropriate. Provide information and direction relevant to coding, to the physicians. Submit charges in a timely manner. All of this is done to support the organization’s mission while living our values.

Job Description

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Outpatient Coding Specialist – Hospital
    • Assigns codes for diagnoses, treatments, and procedures according to the appropriate classification system for outpatient encounters.
    • Utilizes technical coding principals and APC reimbursement expertise to assign appropriate ICD-10-CM/PCS diagnoses and ICD-10-CM/PCS/CPT-4 procedures.
    • Assigns appropriate evaluation/management levels and CPT codes for ER and other chargeable outpatient professional services.
    • Consults with attending physician for clarification when documentation is conflicting or ambiguous in the chart.
    • Extracts required information from source documentation and enters into encoder and abstracting system.
    • Reviews system-generated grouper errors to correct or complete missing data elements.
    • Assists in implementing solutions to reduce back-end billing errors.
    • Maintains a working knowledge of CPT-4 and ICD-10-CM/PCS coding principles, governmental regulations, protocols and third-party requirements pertaining to billing and documentation.
  • Inpatient Coding Specialist – Hospital
    • Performs concurrent coding functions, as assigned.
    • Assigns codes for diagnoses, treatments, and procedures according to the appropriate classification system for inpatient encounters.
    • Reviews appropriate provider documentation to determine principal diagnosis, co-morbidities and complications, secondary conditions and surgical procedures.
    • Utilizes technical coding principals and MS-DRG reimbursement expertise to assign appropriate ICD-10-CM/PCS diagnoses and procedures.
    • Assigns present on admission (POA) value for inpatient diagnoses.
    • Assigns appropriate evaluation/management levels and CPT codes for professional services, and completes appropriate charge tickets for submission to billing for data entry.
    • Consults with attending physician for clarification when documentation is conflicting or ambiguous in the chart.
    • Extracts required information from source documentation and enters into encoder and abstracting system.
    • Identifies non-payment conditions (Hospital Acquired Conditions – HAC) and when required, report through established procedures.
    • Reviews documentation to verify and, when necessary, correct the patient disposition upon discharge.
    • Maintains a working knowledge of CPT-4 and ICD-10-CM/PCS coding principles, governmental regulations, protocols and third-party requirements pertaining to billing and documentation.
  • Professional Services Coder –Clinic
    • Assigns appropriate evaluation/management levels for professional services.
    • Reviews patient medical records to assign codes for diagnoses, treatments, surgical procedures, and nonsurgical procedures for professional services.
    • Maintains a working knowledge of CPT-4 and ICD-10-CM/PCS coding principles, governmental regulations, protocols and third-party requirements pertaining to billing and documentation.
    • Ensures all services documented in the patient’s chart are coded with appropriate diagnoses and procedure codes. When services are not documented appropriately, seeks to attain proper documentation in a timely manner.
    • Consults with attending physician for clarification when documentation is conflicting or ambiguous in the chart.
    • Conducts a review of records to ensure compliance with coding and documentation guidelines and governmental requirements, as assigned.
    • Provides written reports to supervisor or manager with audit results, when assigned.
    • Conducts one-on-one or small group education to physicians, when necessary, regarding the results of their periodic reviews while maintaining an exceptionally high level of professionalism.
    • Provides accurate answers to physician’s coding and billing questions on a timely basis.
    • Ensures maximum efficiency and reimbursement for properly documented services.
    • Reviews, modifies, and recommends changes to policies and procedures to improve professional fee coding and data management.
  • Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official coding guidelines.
  • Demonstrates awareness, understanding and respect of cultural diversity and patients of all ages and socioeconomic groups
  • Other duties as assigned

Required Qualifications

QUALIFICATIONS

Western Wisconsin Health expects employees to understand and to incorporate the values of our organization in their day-to-day practice. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

Minimum Qualifications

  • High school or GED
  • Successful completion (or in progress) of an AHIMA-approved/other accrediting entity-approved Coding Certificate Program
    • RHIA, RHIT, CCS, CCS-P or CCA credentialed
    • Proof of Certification is required and must be keep current throughout employment
    • Recent graduate must obtain certification within 6 months of hire

 

Preferred Qualifications

  • Associate’s Degree
  • 2+ years progressive related experience

 

Other qualifications:

  • Understanding of ICD-10-CM/PCS, HCPCS and CPT coding systems
  • Working knowledge of CMS and other third party payer billing rules, 3M encoder software use, electronic medical record applications
  • Working knowledge of Microsoft Office (Excel, Word, PowerPoint, Outlook)
  • Exhibit excellent communication and organizational skills
  • Ability to manage conflicting priorities and handle multiple tasks/projects concurrently
  • Maintain the integrity of highly confidential business and patient information
  • Display and promote high standards of ethical conduct and behaviors consistent with organizational standards

  

Work schedule:

  • 40 hours per week – Monday-Friday

 

 

ABOUT WESTERN WISCONSIN HEALTH

Western Wisconsin Health is an integrated hospital and family practice clinic located in Western Wisconsin, just 30 minutes from downtown St. Paul on I-94. Join an exciting and growing team with a focus on the future of health care delivery!

Apply Online: https://secure3.saashr.com/ta/6109363.careers?rnd=BTA&ShowAllOpenings=

Posted: November 4, 2019 at 9:46 AM
Post ID: 44584

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