UNIVERSITY OF WASHINGTON

Specification for Class

CLINICAL DATA SPECIALIST-CODER/UTIL MGMT

UW CODE AND REPRESENTATIVE GROUP

8366 (SEIU Local 925 Clerical Nonsupervisory)

BASIC FUNCTION

Assign International Classification of Disease (ICD) and/or Current Procedural Terminology (CPT) codes to diagnoses and operative procedures; perform concurrent and admission review for utilization management function. Obtain initial and final ICD and Diagnostic Related Group (DRG) codes for final reimbursement. Perform data entry and abstract pertinent data from medical records to insure data integrity and accurate 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 direction, analyze medical records to assign ICD and/or CPT codes to assure accurate reimbursement. Utilize classification systems to support the prospective payment systems such as Ambulatory Procedure Code (APC), DRG and Consolidated Decision Systems. Using appropriate criteria, review chart documentation to justify patient care in order to meet agency reimbursement requirements and to justify admission, treatment and length of stay. Obtain retroactive authorizations for admissions. Provide input and support for the discharge planning process throughout a patient stay.

TYPICAL WORK

Obtain and report coding and DRG as requested to facilitate transfers or aid in insurance approval and interim billing;

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;

Review and justify admission and continued stay for all patients as required for insurance reimbursement and government agencies; abstract patient data, obtain initial diagnosis, and determine working diagnostic related group;

Perform admission and concurrent reviews with payor agencies;

Attend patient care rounds and other unit meetings related to resource utilization and discharge management;

Provide appropriate coding for progress billing;

Perform chart analysis;

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;

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;

Evaluate accuracy and completeness of supporting documentation;

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

Develop and maintain unit-specific procedures as required;

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;

Abstract patient data from database system; prepare reports using database system;

Perform techniques to verify data accuracy, integrity and quality;

Assist in the development of databases;

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

Represent department and serve as resource person on various committees;

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

Design quality assurance studies; abstract data for studies, coordinating various studies when necessary;

May train new staff and direct the work of others;

Perform related duties as required.

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

Certified as a Registered Health Information Technician (RHIT) AND two years of experience in health information management

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