Medical Coding Specialist

Group Health Cooperative of South Central Wisconsin. BETTER TOGETHER

The Medical Coding Specialist is responsible for reviewing electronic encounter documents to ensure that the codes provided by the practitioners are accurate per coding protocols and comply with all established guidelines. The Medical Coding Specialist is responsible for assigning applicable codes to the medical records to ensure accuracy and completeness. The incumbent assists in providing coding education and required documentation criteria to practitioners and their staff and participates in job-related research projects. This position is responsible for reviewing insurance claims to determine possible coding errors and researching coding guidelines to support any insurance claim denials based on coding guidelines. As assigned, the incumbent may assist the Medical Coding Manager in various administrative tasks. The Medical Coding Specialist works under the general supervision and guidance of the Revenue Cycle and Insurance Operations Manager.

The incumbent knows and abides by all Group Health Cooperative of South Central Wisconsin (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. The incumbent understands our Mission, Vision, and Common Values (stated below) and is committed to promote these values in behavior and attitude.

JOB SPECIFIC MINIMUM QUALIFICATIONS

1. High school graduation or equivalent is required.

2. Completion of an accredited Medical Coding Specialist Program or equivalent combination of education and/or relevant work experience is required.

3. One (1) year of medical coding experience is preferred. Knowledge of insurance processing is preferred.

4. One (1) year of experience interacting with practitioners regarding coding requirements is preferred.

5. Certification as a CPC or CCS-P is required.

6. Knowledge of CPT/HCPCS (supplies and pharmaceuticals), ICD-10-CM, E/M (evaluation and management), medical records and documentation is required.

7. Knowledge of medical terminology, basic anatomy, physiology, and disease process is required.

8. Knowledge of Medicare and Medicaid rules and regulations is required.

9. 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. Experience with EPIC is highly desirable.

10. Excellent oral and written communication skills are required.

11. 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.

12. Ability to identify coding needs and code accurately is required.

13. Excellent organizational, analytical and problem-solving skills are required.

14. Ability to maintain personnel-related and patient confidentiality. Knowledge of or ability to learn HIPAA requirements.

15. Ability to negotiate with individuals, including practitioners, is required.

16. Ability to adhere to OSHA standards and other patient care protocols is required.

17. Ability to travel among GHC sites on short notice is required.

18. Professional manner necessary to deal courteously and effectively with patients and the public.

Group Health Cooperative of South Central Wisconsin is proud to be an equal opportunity employer. GHC-SCW considers candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.