State of Washington Classified Job Specification
MEDICAL CODING SPECIALIST
Under general direction independently performs professional level work as an internal and external technical specialist for medical diagnostic coding, procedural coding and services performed by qualified healthcare providers.
Positions perform a variety of medical coding functions, such as: analyzing medical records to abstract information for appropriate medical diagnostic and services coding; assigns diagnoses and/or operative procedure codes; converts or corrects medical codes and services; reviews medical records for completeness and accuracy.
Reviews medical records to ensure accurate diagnostic codes and services to assist in recouping or adjusting health care payments and to follow federal mandates and compliance;
Researches medical or legal issues; monitors regulatory and policy requirements that affect ICD coding information;
Performs data entry and abstracts pertinent data from medical records to ensure data integrity and optimal reimbursement;
Performs comprehensive quality assurance or medical records reviews by abstracting medical record data; transfers data to between computer systems to identify trends and recommends corrections, procedural changes, and educational opportunities for internal staff and providers;
Trains external and/or internal health care providers and staff on medical diagnostic codes and services;
May lead or train staff performing same or similar duties within work unit or work group;
Performs other duties as required.
Knowledge and Abilities
Knowledge of: anatomy, physiology, medical terminology and medical coding guidelines, regulations and medical practice specialty.
Ability to: abstract information required to support accurate medical diagnostic coding; work effectively with program staff, medical providers, and other affected parties; communicate clearly and effectively both orally and in written form.
There may be instances where individual positions must have additional licenses or certification. It is the employer’s responsibility to ensure the appropriate licenses/certifications are obtained for each position.
At least two years of experience in medical coding, medical billing, medical policy making or fee schedule creation with an emphasis on diagnosis coding.
Current certification as a Certified Professional Coder with the American Association of Professional Coders (or equivalent) or ability to obtain certification within two years of hire.
Class Specification History
New class. Adopted June 13, 2019, effective July 1, 2019.