Coding Specialist II

Medical College of Wisconsin; Milwaukee (WI); On-site; USD 42,000 - 65,000; Full time

Benefits offered by this job

Healthcare coverage

403B retirement plan

Paid vacation and holidays

Tuition reimbursement

Parental leave

Employee assistance program

Job summary

Medical College of Wisconsin seeks an experienced coding/billing professional to perform CPT and ICD-10 CM coding with accuracy and timeliness. You will liaise with physicians, department admins, and billing staff to coordinate professional service billings across clinical departments.

You will monitor charge flow, resolve edits, participate in provider education, and help reduce denials by ensuring compliant documentation and coding practices.

Qualifications

• Working knowledge of CPT and ICD-10 CM coding requirements.
• Understanding of medical insurance guidelines and governmental policies.
• Progressive computer skills and attention to detail.
• Ability to collaborate with clinicians, administrators and billing staff.

Responsibilities

• Charge processing: assign or verify CPT and ICD-10 CM coding and modifiers based on documentation.
• Resolve edits for electronic charges to ensure complete data (CPT, ICD-10 CM, modifiers, provider, billing area).
• Enter charges as needed to support accurate billing.
• Reconcile charges by monitoring flow and liaising with managers and staff to obtain missing information.
• Identify and resolve coding and reimbursement issues and reduce denials.
• Develop and maintain protocols for assigned billing areas.
• Educate providers on documentation policies and participate in orientations.

Skills

CPT coding

ICD-10 CM coding

Insurance guidelines

Computer skills

Detail oriented

Education

High school diploma or equivalent

Job description

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.

Primary Responsibilities

• CHARGE PROCESSING:
  • Assignment or verification of CPT, ICD-10 CM coding and modifiers based upon documentation. (Inpatient/Emergency Department abstraction, ambulatory coding 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.
  • 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 change 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

Working knowledge of CPT and ICD-10 CM coding. Understanding of medical insurance guidelines and governmental policies. Progressive computer skills. Detail oriented. Ability to establish and maintain effective working relationships with the team and department staff (including administrative staff and faculty). Meet or exceed established production rate and performance standards.

Qualifications

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

Minimum Required Education

High school graduate or equivalent

Minimum Required Experience

2 years of related coding and/or health care experience

Required Certification/Licensure(s)

Coding certification (CPC, CPC-A, CCS-P, or CCA) and/or Health Information Management credential (RHIT or RHIA).

Preferred Experience

Office experience

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.

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.