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:
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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)
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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.
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Knowledge of EMR’s and electronic charge workflows
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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
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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.
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Provide out of office coding coverage to other team members.
- Charge Entry as needed
RECONCILIATION OF CHARGES:
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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
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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
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Develop and maintain all protocols related to their assigned areas.
PROVIDER EDUCATION
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Maintain understanding all Teaching Physician and provider documentation policies.
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Actively participate in new provider orientations.
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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).
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. A