UNIVERSITY OF WASHINGTON

Specification for Class

CLINICAL DATA SPECIALIST - CODER

UW CODE AND REPRESENTATIVE GROUP

8364 (SEIU Local 925 Clerical Nonsupervisory)

BASIC FUNCTION

Assign International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes to diagnoses and operative procedures; perform data entry and abstract pertinent data from medical records to insure data integrity and optimal reimbursement. Process patient data requests using database systems. Design quality assurance studies and abstract data; perform data verification and transfer data between computer systems.

DISTINGUISHING CHARACTERISTICS

Under general supervision, analyze medical records to assign ICD and/or CPT codes to assure optimal reimbursement. Utilize classification systems to support the prospective payment systems such as Ambulatory Procedure Codes (APC), Diagnostic Related Groups (DRG) and Consolidated Decision Systems.

TYPICAL WORK

Work with health information management-related applications (transcription, dictation deficiency tracking, chart locator, abstraction, encoder, registration, master patient index, registries, clinical data repository, and quality management) to gather clinical data to support the selection of codes or criteria;

Validate codes entered at the point of care by reviewing electronic data and suggesting clarifications, revisions, and additional information;

Analyze clinical data, interpret information, and present the data that is useful for the multidisciplinary team;

Assign ICD codes to diagnoses in an integrated system of inpatient, outpatient, ambulatory records and other specialized service areas;

Utilize classification systems, such as Diagnostic and Statistical Manual (DSM), Systematized Nomenclature for Medicine (SNOMED), morphology coding, ICD and CPT to assign the appropriate code selection for consolidated decision support and for prospective payment system such as APC and DRG.

Interpret data for reimbursement application;

Enter and verify all coded and demographic data into the encoder/abstractor systems;

Identify the need for documentation clarity to support the integrity of the record and for reimbursement compliance;

Share information about data collection models such as prospective payment and classification systems and compliance programs such as Health Insurance Portability and Accountability Act (HIPPA) and new legislation impacting the Academic Medical Centers;

Interpret reimbursement reports and recommend proactive responses to problems identified;

Perform techniques to verify accuracy, integrity and quality of data;

Perform analysis of claims and billing reviews;

Evaluate accuracy and completeness of supporting documentation;

Provide patient data requests on database system and prepare reports;

Assist in the development of databases;

Review Medicare claims for accuracy of ICD, CPT, Evaluation and Management (E/M) coding and modifiers;

Assist in the development and maintenance of policies and procedures for coding;

Represent department and serve as resource person on various committees;

Assist in the development and maintenance of the coding manual and standards;

Design quality assurance studies; abstract data for studies; coordinate various studies when necessary;

Communicate with providers to clarify documentation for such areas as problem list, reason for visit, care plan, diagnoses and procedures;

May direct or coordinate the work of others;

May train new staff;

Perform related duties as required.

MINIMUM QUALIFICATIONS - UW Contract Classified
DESIRABLE QUALIFICATIONS - Classified Non-Union

Certified as a Registered Health Information Technician (RHIT) AND one year of ICD and CPT coding experience using a broad knowledge of coding standards and guidelines

OR

equivalent education/experience.

New Class: 4-18-88
Revise Class/Title: 9-25-92
Revise Class/Title: 9-1-02

CSR Class Conversion (mc): 06-01-05