Medical Coding - Medical Coding Specialist

Group Health Cooperative of South Central Wisconsin Madison, WI 2017-02-22

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 COB/Medical Billing and Coding Manager.

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.

Our Mission Statement : To provide accessible, comprehensive, high quality healthcare and outstanding service in an efficient and personalized manner on a prepaid basis to persons in the GHC-SCW service area.

Our Vision : To be a leader among HMO’s in providing high-quality medical care, impeccable service and competitive benefit levels and premium rates.

Our Common Values :
  • Patient Centered: When health insurers and health care providers are brought together under one roof, we are better together . Our care team model focuses on supporting the needs of our patients/members and providing the best in safe, high quality coordinated health care. Members and their providers participate in making meaningful decisions that lead to better outcomes.
  • Quality Driven: When members and their providers each participate meaningfully in the decisions that lead to better health care, we are better together . GHC-SCW continues its tradition of providing proactive health promotion and disease management outreach to our members to consistently achieve high quality health care accreditation.
  • Innovation: When we work to lift each other up, show appreciation and collaborate in the best interests of the member, we are better together . GHC-SCW has made innovative advancements which include the implementation of an electronic medical records system (EMR) and GHC-SCW MyChart SM, access to innovative Complementary Medicine benefits and Wellness reimbursement services.
  • Community Involved: When we join with our community to further the causes for which we share a common concern, we are better together . We are proud to promote programs that strengthen lives, and make our community a safer, stronger and healthier place to live and grow. GHC-SCW employees share their time and talent; and we recognize that the value of what we give is also what we gain – for our employees, our members and our community.
  • Not for Profit Cooperative: When we share a common purpose, a common voice and a common vision, we are better together . We use our surpluses to improve clinics, enhance health care benefits and give back to the community. Our members, not our profits, are our priority. We have a unique “cooperative” governance structure which works directly for our members.

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.

Minimum of one (1) year of medical coding experience is preferred. Knowledge of insurance processing is preferred.

Certification as a CPC or CCS-P is preferred or the ability to become CPC certified within one (1) year of employment is required.

Knowledge of CPT/HCPCS (supplies and pharmaceuticals), ICD-9-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.

Minimum of one (1) year of experience interacting with practitioners regarding coding requirements is preferred.

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.

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.
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