[Hiring] Coding Specialist 1 - Edits Coder @University of Washington

Role Description

The Edits Coder position reports to the Outpatient Coding Supervisor within the Enterprise Records and Health Information Management department. Under the general supervision of the Manager of Facility Coding, and the direct supervision of the Supervisor of Outpatient Coding, the Edits Coder is responsible for implementing the mission and goals of Enterprise Records and Health Information, and incorporating a “patients are first” service culture. The Edits Coder is responsible for performing daily activities related to analyzing medical records to validate the correct coding assignment of International Classification of Disease (ICD), Current Procedural Terminology (CPT) and/or Healthcare Common Procedure Coding System (HCPCS) codes in Epic work queues (WQ) and/or Hierarchical Condition Category (HCC)/Risk Adjustment Factor (RAF) and/or Care Gap review to ensure optimal reimbursement for facility and/or professional fee coding and billing for Clinic, Outpatient and related charges needing coding review in compliance with State and Federal guidelines.

Primary Job Responsibilities

• Validates codes entered at the point of care and/or by other charge sources by reviewing electronic data and making corrections based on a review of all available electronic and other appropriate documentation to support all billable procedures and services.
• Reviews and resolves coding accounts failed validations, revenue guard, missing modifiers, incorrect modifiers, missing charges, incorrect charges, medical necessity edits, CCI edits, claim edits, and payor denials in Epic; verifies accuracy of ICD diagnosis codes and CPT/HCPCS procedure codes.
• Investigates and researches coding issues identified by Revenue Integrity (RI) and Patient Financial Services (PFS) related to inquiries, complaints and/or denials. Makes coding corrections to resolve coding issues; supports RI by reviewing specified procedures for charge accuracy; reroutes accounts to correct coding team for coding resolution based on revenue codes.
• Maintains Epic WQ turnaround times for coding error and edits resolution to prevent charge lags for facility and professional fee services. Identifies potentially avoidable delays to timely billing and helps identify systemic issues that contribute to delays in service or inefficient uses of resources to address root cause and prevent ongoing errors.
• Identifies the need for documentation clarity to support the integrity of the record and for reimbursement compliance; identifies charge error trends and escalates to supervisor.
• Performs special projects or other duties assigned.
• May perform the work of lower level classifications of the Coding Specialist series.

Qualifications

• High school diploma or equivalent
• Certified as a Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Certified Coding Specialist – Physician Based (CCS-P), Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), Certified Outpatient Coder (COC), Certified Interventional Radiology Cardiovascular Coder (CIRCC), Radiology Certified Coder (RCC) or Radiation Oncology Certified Coder (ROCC).
• One year coding experience or equivalent education/experience.
• Equivalent education and/or experience may substitute for minimum qualifications except when there are legal requirements, such as a license, certification, and/or registration.

Requirements

• Pay Range Minimum: $29.41 hourly
• Pay Range Maximum: $42.10 hourly
• Shift: First Shift (United States of America)
• Temporary or Regular: This is a regular position
• FTE (Full-Time Equivalent): 100.00%
• Union/Bargaining Unit: SEIU Local 925 Nonsupervisory

Benefits

• For information about benefits for this position, visit https://www.washington.edu/jobs/benefits-for-uw-staff/