Coding Quality Analyst - Clinical Practice Services

Summary

Serves as an expert resource for multi-specialty documentation, coding and billing. Assist in performing medical coding audits on clinicians and/or coding staff as needed within multi-specialty physician practices to identify deficiencies and ensure coding remains compliant with coding guidelines as well as government and third-party payer regulations and guidelines. Responsible for new and existing clinician and coder education, as well as team and/or clinical department educational sessions.

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

Primary Responsibilities

• Expert resource of multispecialty coding, charge capture and reimbursement which may include surgical, inpatient, emergency and/or ambulatory coding; assignment or verification of CPT, ICD-10 CM coding and modifiers based upon documentation.
• Participate in workgroups to evaluate, produce and/or update policies and procedures related to internal process in relation to documentation, coding, and billing.
• Educate/train new and existing employees in multispecialty clinical areas, include government documentation and coding regulations. Assist lead/CS IV team in educational session, include coding/charge capture process and Epic related changes.
• Onboard/educate new and existing physicians and APP’s on documentation and coding rules and regulations.
• Perform documentation and coding audits on clinicians and coding specialist staff for coding accuracy.
• Support Charge Capture Team in analyzing coding denial trends and troubleshooting solutions such as front-end system edits and/or front-end education to minimize reimbursement delays.
• Assist in the training of coworkers, coding staff, clinicians as appropriate to provide evaluation, education and/or orientation adhering to CPT, ICD-10CM and Government documentation and coding regulations.
• Subject Matter Expert for Encoder Pro.
• Participates in new employee orientation to acquaint them with the charge capture process.
• Maintain current knowledge of medical terminology, procedure codes, modifiers, diagnosis codes, coding requirements and practices. Communicates changes to appropriate persons.
• Review payer policy publications, notices and websites for coding and policy information to assist in appeal writing or to support other action determinations.
• Responsible for the day-to-day prioritization and the execution of various projects.
• Perform other duties or projects as assigned.
• Other duties as assigned.

Knowledge – Skills – Abilities

• Ability to interact with people effectively.
• Expert knowledge of medical billing and collections revenue cycle as it specifically relates to professional medical coding, reimbursement, contracting and processing payments.
• Strong written and oral communication skills.
• Ability to take initiative and to exercise independent judgment, decision making and problem-solving skills.
• Proficient in Excel and Word, Medical terminology, CPT, HCPCS, ICD-10CM coding, CMS coding requirements, and coding tools.

Qualifications

Appropriate experience may be substituted for education on an equivalent basis.

Minimum Required Education: Bachelor’s Degree

Minimum Required Experience: 6 years

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

Preferred Experience: Front end professional coding, Epic, Encoder Pro

Target salary range for this position is between $75,300.00 and $95,900.00 annually. The final offered salary will depend on the applicant’s education, experience, skills, and knowledge, as well as considerations of internal equity and market alignment.

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