Medical Coding Specialist

Group Health Cooperative of South Central Wisconsin. BETTER TOGETHER

The Medical Coding Specialist is responsible for reviewing electronic encounter documentation to verify that practitioner-submitted codes are accurate, adhere to coding protocols, and comply with all applicable guidelines. This role also involves assigning appropriate codes to medical records to ensure their accuracy and completeness. Additionally, the Specialist supports practitioners and their staff by providing education on coding practices and documentation requirements and may contribute to coding-related research projects. The position includes reviewing insurance claims to identify potential coding errors and researching coding standards to address denials based on coding issues. As needed, the Specialist may assist the Medical Coding Manager with administrative duties. This position operates under the general supervision of the Medical Coding Supervisor.

GHC-SCW is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. In dedication to the health and well-being of our employees, we offer a comprehensive benefits package that includes health and dental insurance, along with paid short-term disability, long-term disability, and life insurance. Additional benefits include a flexible spending account, employee assistance programs, tuition reimbursement, pet insurance, eyewear discounts, and more. Check us out by clicking on Many Talents, One Mission! The Benefits of Working at GHC-SCW.

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. Experience with EPIC is highly desirable.
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. Minimum of one (1) year of experience interacting with practitioners regarding coding requirements is preferred.
10. Knowledge of or ability to learn various computer programs such as MS Office Suite, word processing, database, calendar and email is required.
11. Knowledge of or ability to learn and effectively use systems including electronic medical record and electronic coding systems is required.
12. Excellent oral and written communication skills are required.
13. 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.
14. Ability to identify coding needs and code accurately is required.
15. Excellent organizational, analytical and problem-solving skills are required.
16. Ability to maintain personnel related and patient confidentiality is required. Knowledge of or ability to learn HIPAA requirements.

1. Ability to negotiate with individuals, including practitioners, is required.
2. Ability to adhere to OSHA standards and other patient care protocols is required.
3. Ability to see at near and mid-range is required.
4. Ability to use a keyboard regularly is required.
5. Ability to travel among GHC sites on short notice is required.
6. Manual dexterity, including the ability to perform fingering and handling with both hands is required.
7. Ability to intermittently sit, stand, bend, stoop and stretch is required.

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

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.

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.