UW CODE AND REPRESENTATIVE GROUP

8367 (SEIU Local 925 Clerical Nonsupervisory)

BASIC FUNCTION

Lead Clinical Data Specialists and/or others and perform utilization management and/or coding functions.

DISTINGUISHING CHARACTERISTICS

Regularly assign, instruct and check the work of others. Direct the work flow of utilization management and/or coding staff. Assist in the coordination of specialized division activities.

TYPICAL WORK

Lead assigned staff in the performance of utilization management and/or coding functions;

Respond to inquiries regarding utilization or coding problems;

Prepare departmental reports and statistical summaries;

Assist in the development, review and implementation of departmental policies and procedures;

Assist with the coordination of coding/utilization reviews for external agencies;

Assist in interviewing, checking references, and selecting staff; assist in evaluating staff performance and participate in recommending training opportunities; identify performance deficiencies; participate in recommending disciplinary action;

Participate in the development of departmental priorities, goals and process improvement opportunities;

Provide data input and observation for performance reviews;

Monitor and ensure appropriate tools and resources needed for departmental functioning;

Monitor and report system performance issues;

Facilitate effective communication between internal and external customers;

Act as expert systems user for basic systems problem solving;

Analyze and monitor medical records to assign appropriate International Classifications of Diseases (ICD) and/or Current Procedural Terminology (CPT) codes (in consultation with health care team if necessary) using coding principles and guidelines to obtain optimal reimbursement; enter and retrieve data from case-mix system;

Refer patients with potential continuing care needs to appropriate departments such as social services, pharmacy and/or financial services;

Complete admission/concurrent reviews, progress billings, patient stay extension requests and discharge patient coding to facilitate reducing the accounts receivable days outstanding;

Perform the work of Clinical Data Specialists;

May provide leadership in committee functions;

Perform related duties as required.

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

Certified as a Registered Health Information Technician (RHIT) AND three years of ICD and/or CPT coding or utilization management experience

OR

equivalent education/experience.

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