Medical Coding Specialist

Group Health Cooperative of South Central Wisconsin•Madison, WI

1d•Onsite

About The Position

The Medical Coding Specialist is responsible for reviewing electronic encounter documentation to verify that practitioner-submitted codes are accurate, adhere to coding protocols, and comply with all applicable guidelines. This role is responsible for accurately assigning medical codes to patient records and supporting providers through education on coding and documentation requirements while contributing to coding-related initiatives and research as needed. The position includes reviewing insurance claims to identify potential coding errors and researching coding standards to address denials based on coding issues. As needed, the Specialist may assist the Medical Coding Manager with administrative duties. This position operates under the general supervision of the Medical Coding Supervisor.

Requirements

High school graduation or equivalent is required.
Graduation from an accredited Medical Coding Specialist Program or equivalent combination of education and/or relevant work experience is required.
Certification as a CPC or CCS-P is required.
Knowledge of CPT/HCPCS (supplies and pharmaceuticals), ICD-10-CM, E/M (evaluation and management), medical records and documentation is required.
Knowledge of medical terminology, basic anatomy, physiology, and disease process is required.
Knowledge of Medicare and Medicaid rules and regulations is required.
Knowledge of or ability to learn various computer programs such as MS Office Suite, word processing, database, calendar and email is required.
Knowledge of or ability to learn and effectively use systems including electronic medical record and electronic coding systems is required.
Excellent oral and written communication skills are required.
Excellent customer service skills and the ability to work with a diverse patient population is required.
Ability to work harmoniously and cooperatively with all staff and the public is required.
Ability to identify coding needs and code accurately is required.
Excellent organizational, analytical and problem-solving skills are required.
Ability to maintain personnel related and patient confidentiality is required.
Knowledge of or ability to learn HIPAA requirements.
Ability to negotiate with individuals, including practitioners is required.
Ability to adhere to OSHA standards and other patient care protocols is required.
Ability to see at near and mid-range is required.
Ability to use a keyboard regularly is required.
Ability to travel among GHC sites on short notice is required.
Manual dexterity, including the ability to perform fingering and handling with both hands is required.
Ability to intermittently sit, stand, bend, stoop and stretch is required.
The incumbent knows and abides by all GHC-SCW organizational and departmental policies, sets personal standards and strives for high quality work in completing assignments, performs job duties in a timely manner, and represents the organization in a positive manner.

Nice To Haves

Minimum of one (1) year of medical coding experience is preferred.
Knowledge of insurance processing is preferred.
Experience with EPIC is highly desirable.
Minimum of one (1) year of experience interacting with practitioners regarding coding requirements is preferred.

Responsibilities

Reviewing electronic encounter documentation to verify that practitioner-submitted codes are accurate, adhere to coding protocols, and comply with all applicable guidelines.
Accurately assigning medical codes to patient records.
Supporting providers through education on coding and documentation requirements.
Contributing to coding-related initiatives and research as needed.
Reviewing insurance claims to identify potential coding errors.
Researching coding standards to address denials based on coding issues.
Assisting the Medical Coding Manager with administrative duties as needed.
Adhering to OSHA standards and other patient care protocols.
Maintaining personnel related and patient confidentiality.
Negotiating with individuals, including practitioners.