Coding Quality Analyst - Clinical Practice Services

The Medical College of Wisconsin, Inc.; Wisconsin; Hybrid; USD 75,000 - 96,000; Full time

Benefits offered by this job

Health insurance

Vision coverage

Dental

403B retirement

Paid holidays

Tuition reimbursement

Paid parental leave

EFAP

Onsite fitness facility

Job summary

The Medical College of Wisconsin, Inc. seeks an expert Medical Coding Auditor to join our multispecialty coding, charge capture and reimbursement team.

You will audit clinician and coder work, educate staff on CPT/ICD-10-CM rules, and help implement policies and training across departments. Responsibilities include leading audits, addressing denial trends, onboarding physicians and APPs, and staying current with coding regulations.

Qualifications

• Bachelor’s Degree required;6+ years experience in medical coding or related field
• CPC/CCS-P or RHIT/RHIA certification required
• Strong knowledge of CPT, ICD-10-CM and modifiers

Responsibilities

• Serve as expert resource for multispecialty coding and charge capture.
• Educate/train clinicians and staff in coding regulations.
• Conduct documentation and coding audits for accuracy.
• Assist in training and onboarding physicians and APPs.
• Review payer policies and assist in appeals.
• Support denial analysis and front-end education.

Skills

Medical coding knowledge

Billing/revenue cycle

Communication skills

Excel and Word

Epic

Encoder Pro

CPT/ICD-10-CM

Education

Bachelor’s Degree

CPC or CCS-P

RHIT or RHIA

Tools

Epic

Encoder Pro

Job description

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 #LI-RT1

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.

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

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 on a protected characteristic.

About Us Together, we can build a healthier world. A student, an educator, a scientist and a community leader — alone, they can do many things. Together, the question isn’t what they can do, but what can’t they. The Medical College of Wisconsin (MCW) brings together the most inquisitive, passionate minds in science, medicine, education and community engagement to tackle today’s toughest challenges in health and society. Academic medicine is at the center of where scientists, physicians and students work hand-in-hand with the community to ask the most important questions and fuel the cycle of innovation that shapes the future of medicine. Medical College of Wisconsin The tireless pursuit of knowledge and the power of academic medicine is at the core of everything we do at MCW. Bringing together the world’s top scientists and clinicians, inspired students and invested communities, we are driven to solve the most complex challenges in health and society. With around 1,600 full-time and part-time faculty and approximately 3,500 full-time employees, MCW is home to a diverse group of thought leaders working in collaboration to pioneer pathways to a healthier world and drive a continuous cycle of life-changing discovery.