Coding Specialist III - Clinical Practice Services

Summary

Perform coding and related duties using established billing office policies in an accurate and timely manner.  Primary contact with physicians, department administrators, hospital and/or clinical department administrators and their support staff and billing staff. Coordinates professional service billings for selected clinical departments. Assist in the analysis, development and implementation of new professional service lines related to coding, billing and charge capture.

All remote work must be performed within one of the MCW registered payroll states, which currently includes: WI, AL, AZ, DE, FL, GA, IN, MD, MI, MN, MO, NC, TN, TX, & UT.

Primary Responsibilities

CHARGE PROCESSING:

• Assignment or verification of CPT, ICD-10 CM coding and modifiers based upon documentation.  (Subject matter expert in a single specialty and/or crossed trained to cover multiple surgical/medical specialties for abstraction, ambulatory and/or surgical/procedural coding)

• Resolve edits for electronic charges, following established policies and procedures to ensure that all data elements (claim requirements – CPT, ICD-10 CM, modifiers, provider, billing area, etc.) are applied.

• Knowledge of EMR’s and electronic charge workflows

• Serve as a resource to staff for accurate assignment of CPT procedure and ICD-10-CM diagnosis coding for single or multi-specialty services for appropriate reimbursement

• Resolve edits for electronic charges, following established policies and procedures to ensure that all data elements (claim requirements – CPT, ICD-10 CM, modifiers, provider, billing area, etc.) are applied.

• Provide out of office coding coverage to other team members.

• Charge Entry as needed

RECONCILIATION OF CHARGES:

• Monitor charge flow and act as a liaison with managers, department administrators and other billing personnel to assure consistent and accurate chage flow. Work with clinic staff and physicians regarding missing or unclear information that is required for billing

CLAIM DENIALS / BILLING ISSUES

• Identify, report, and resolve coding and reimbursement issues.  Working with physicians, department administrators and other billing office staff, including reimbursement staff. Identify opportunities to reduce denials and enhance revenue.

PROTOCOLS

• Develop and maintain all protocols related to their assigned areas.

PROVIDER EDUCATION

• Maintain understanding all Teaching Physician and provider documentation policies.

• Actively participate in new provider orientations. 

• Note and address trends in provider documentation that may impact coding and billing.

Knowledge – Skills – Abilities

Advanced knowledge of CPT, ICD-10 CM coding, payer, and governmental policies. Excellent oral and written communication skills.  Detail oriented.  Ability to establish and maintain effective working relationships with the team and departmental staff (including administrative staff and faculty).  Ability to work independently.  Excellent computer skills. Knowledge of EMR’s and electronic charge workflows. Meet or exceed established production rate and performance standards.

Qualifications

Minimum Required Education: High School diploma

Minimum Required Experience: 3 years

Required Certification/Licensure(s): Coding certification (CPC or CCS-P) and/or Health Information Management credential (RHIT or RHIA).

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Physical Requirements

Work requires occasionally lifting moderate weight materials, standing, or walking continuously.

Work Environment

Occasional exposure to dust, noise, temperature changes, or contact with water or other liquids. Work is performed in an environmentally controlled environment.

Sensory Acuity

Ability to detect and translate speech or other communication required. May occasionally require the ability to distinguish colors and perceive relative distances between objects.

Why MCW?

• Outstanding Healthcare Coverage, including but not limited to Health, Vision, and Dental. Along with Flexible Spending options
• 403B Retirement Package
• Competitive Vacation and Paid Holidays offered
• Tuition Reimbursement
• Paid Parental Leave
• Employee & Family Assistance Program (EFAP)
• Pet Insurance
• On campus Fitness Facility, offering onsite classes
• Additional discounted rates on items such as: Select cell phone plans, local fitness facilities, Milwaukee recreation and entertainment etc.

For a brief overview of our benefits see: Benefits Overview

For a full list of positions see: MCW Careers

At MCW all of our endeavors, from our internal operations to our interactions with our partners, are driven by our shared organizational values: Caring – Collaborative – Curiosity – Inclusive – Integrity – Respect. We are committed to fostering an inclusive environment that values diversity in backgrounds, experiences, and perspectives through merit-based processes and in alignment with all applicable laws. We believe that embracing human differences is critical to realize our vision of a healthier world, and we recognize that a healthy and thriving community starts from within. Our values define who we are, what we stand for and how we conduct ourselves at MCW. If you believe in embracing individuality and working together according to these principles to improve health for all, then MCW is the place for you. For more information, please visit our institutional website.

MCW as an Equal Opportunity Employer and Commitment to Non-Discrimination:

The Medical College of Wisconsin (MCW) is an Equal Opportunity Employer. We are committed to fostering an inclusive community of outstanding faculty, staff, and students, as well as ensuring equal educational opportunity, employment, and access to services, programs, and activities, without regard to an individual's race, color, national origin, religion, age, disability, sex, gender identity/expression, sexual orientation, marital status, pregnancy, predisposing genetic characteristic, or military status. Employees, students, applicants or other members of the MCW community (including but not limited to vendors, visitors, and guests) may not be subjected to harassment that is prohibited by law or treated adversely or retaliated against based upon a protected characteristic.