The mission of University of Washington MEDICINE is to improve the health of the public by advancing medical knowledge, providing outstanding primary and specialty care to the people of the region, and preparing tomorrow's physicians, scientists and other health professionals. UW MEDICINE owns or operates the following: Harborview Medical Center, Northwest Hospital & Medical Center, Valley Medical Center, UW Medical Center (UWMC), a network of UW MEDICINE Neighborhood Clinics that provide primary care, UW Physicians, UW School of MEDICINE, Airlift Northwest, and other owned, operated, or affiliated entities as appropriate. In addition, UW MEDICINE shares in the ownership and governance of Children's University Medical Group and Seattle Cancer Care Alliance a partnership among UW MEDICINE, Fred Hutchinson Cancer Research, and Seattle Children'sWe have an exciting opportunity for a CODING SPECIALIST 3, PATHOLOGYUnder general direction, analyze medical records to assign ICD-10-CM, CPT, E&M, HCPCS codes to assure optimal reimbursement. Utilize classification systems to support the prospective payment systems such as Ambulatory Procedure Classifications, Diagnostic Related Groups and Consolidated Decision Support Systems. Apply appropriate InterQual criteria while reviewing chart documentation to determine inpatient, observation or Ambulatory Surgery status of patient records, verify treatment and length of stay, analyze criteria to ensure correct code assignment, DRG, and reimbursement in compliance with federal guidelines. Possess a high level of knowledge of Anatomy and medical terminology in order to code the highly complex records of a Level I trauma center.The CODING SPECIALIST 3 PATHOLOGY will:Assign and report coding and final DRG or APC assignment to demonstrate transfer or discharge of the patient to ensure appropriate reimbursement for the facility.Work with health information management-related applications (deficiency tracking, chart locator, abstractor, encoder, registration, master patient index, registries, clinical data repository, and quality management) to gather clinical data to support the selection of codes.Review patient records using InterQual inpatient or observation criteria to determine whether a patient was admitted appropriately to the facility. Report these findings to Utilization Management and Patient Financial Services to help assist with procedures to admit patients appropriately and bill appropriately as well.Review patient records upon admission to the Rehabilitation Unit; assign codes to each record to assure proper CMG assignment and appropriate reimbursement to the facility for Medicare rehab patients.Analyze clinical data, interpret information, and present the data for multidisciplinary team.Assign ICD-10-CM codes to complex trauma diagnoses and procedures in an integrated system of inpatient, outpatient, ambulatory records, and mental health records.Abstract patient data to ensure data integrity, accurate reimbursement, proper case mix and hospital decision support.Utilize classification systems such as Diagnostic and Statistical Manual (DSM), Systematized Nomenclature for Medicine (SNOMED), morphology coding, HCPCS II, Evaluation and Management codes, ICD-10-CM and CPT as appropriate code selection for Consolidated Decision Support, reimbursement for the facility by assigning the proper APC or DRG. Also to facilitate proper billing for physician fees.Review patient records such as nursing documentation and treatment records, to determine the charges for that visit. Complete a professional fee sheet for each record reviewed utilizing InterQual criteria to assure proper billing of each record.Interpret data for reimbursement applications.Enter and verify all coded and demographic data into the encoder/abstracting system to facility multi-disciplinary decision support and data retrieval.Participate in internal and external review and audits of patient records.Participate with auditors in onsite prebilling, quarterly audits to ensure accuracy of coded data and DRG assignment to promote continual quality improvement.Design and implement data collection instruments for reporting of documentation, coding and billing findings.Perform analysis of claims prior to billing to assure outpatient bills are sent out without any CCI edits unresolved.Investigates and researches billing and coding issues as related to inquiries, complaints, or audit results.Share information about data collection models such as prospective payment classification systems and compliance programs such as Health Insurance Portability and Accountability Act (HIPAA) and new legislation impacting the Academic Medical Center.Serves as a resource for current coding, billing, and regulatory guidelines.Interpret reimbursement reports and recommend proactive responses to problems identified.Perform audits to verify accuracy, integrity and quality of data.Evaluate accuracy and completeness of supporting documentation.Prepare reports for data information requests from the abstracting/encoding system.Assist in development of Policy, Procedures and database collection.Review claims for accuracy of ICD-9-CM, CPT, E/M, HCPCS coding and the proper use of modifiers.Provide support to medical center physicians and staff for documentation and coding review questions.Produce outcome statistics and reports as requested.Abstract and report clinical pathway data to facilitate internal decision support and tracking.Perform proactive techniques to verify accuracy, integrity, and quality of data before finalization of bill processing.Identify documentation issues in patient records. Query physician for clarification of documentation issue and request record addendum to the record to make that clarification.Assist with development of coding manuals, standards, and policies and procedures.Assist in the design of quality assurances studies, abstract data for these studies and report data for these studies as requested.Communicate with providers who are clarifying documentation for such areas such as problem list, reason for visit, care plan, diagnoses, procedures and pharmaceuticals.May assist or coordinate the work assignments with other staff members.May assist with the training of new employees.Perform special projects as assigned.REQUIREMENTSHigh school diploma or equivalentANDCertified 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).ANDThree years coding experience or equivalent education/experience.ADDITIONAL DEPARTMENTAL REQUIREMENTS:Certification of RHIT, RHIA, or CCS. Two years experience in ICD-10-CM, CPT, E/M coding Preferable, one year coding experience at a level I trauma center, to include burns, multiple trauma, Neuro/Ortho surgical catastrophic injury related diseases and/or medical complications using a broad knowledge of coding guidelines and standards. Experience or education in utilization management and InterQual criteria, a plus. Experience with health care billing, coding, and compliance, a plus. Comprehensive knowledge of Federal health care billing rules and regulations. Experience with E&M, CPT, ICD-9 and HCPCS coding. Proficiency with PowerPoint, MS Word and Excel. Excellent and effective oral and written communication skills. Self-motivated, detail-oriented and highly organized skill set.*Equivalent work experience may substitute for education requirements.
Founded in 1861, the University of Washington is one of the oldest public institutions in the west coast and one of the preeminent research universities in the world. The University of Washington is a multi-campus university comprised of three different campuses: Seattle, Tacoma, and Bothell. The Seattle campus is made up of sixteen schools and colleges that serve students ranging from an undergraduate level to a doctoral level. The university is home to world-class libraries, arts, music, drama, and sports, as well as the highest quality medical care in Washington State and a world-class academic medical center. The teaching and research of the University’s many professional schools provide undergraduate and graduate students the education necessary toward achieving an excellence that will serve the state, the region, and the nation. As part of a large and diverse community, the University of Washington serves more students than any other institution in the Northwest.