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 Medical Coding Supervisor. 

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: We partner with members and the communities we serve to maximize health and well-being.

Our Vision: As a local, not-for-profit, member-owned Cooperative, we are the most trusted resource for lifelong health and well-being in the communities we serve.

Our Values:

• We are a not-for-profit Cooperative
• We are member-centered
• We are equitable and inclusive
• We are quality-driven
• We are innovative
• We are community involved

GHC-SCW is committed to fostering a caring and compassionate environment while ensuring that individual differences are valued. GHC-SCW is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. It is essential that all employees, members, and patients feel secure and welcome, that the opinions and contributions of all individuals are respected and that all voices are heard.

We believe:

Healthcare is a human right.

In treating all people with dignity and respect.

There is strength in diversity.

Equity celebrates our humanity.

We are better together.

JOB SPECIFIC MINIMUM QUALIFICATIONS 

1. High school graduation or equivalent is required.
2. Graduation from an accredited Medical Coding Specialist Program or equivalent combination of education and/or relevant work experience is required.
3. Minimum of one (1) year of medical coding experience is preferred.  Knowledge of insurance processing is preferred.
4. Certification as a CPC or CCS-P is required.
5. Knowledge of CPT/HCPCS (supplies and pharmaceuticals), ICD-10-CM, E/M (evaluation and management), medical records and documentation is required.
6. Knowledge of medical terminology, basic anatomy, physiology, and disease process is required.
7. Knowledge of Medicare and Medicaid rules and regulations is required.
8. Minimum of one (1) year of experience interacting with practitioners regarding coding requirements is preferred.
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 is required. 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 see at near and mid range is required.
18. Ability to use a keyboard regularly is required.
19. Ability to travel among GHC sites on short notice is required.
20. Manual dexterity, including the ability to perform fingering and handling with both hands is required.
21. Ability to intermittently sit, stand, bend, stoop and stretch is required.

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.