Coding Specialist III - Clinical Practice Services

The Medical College of Wisconsin, Inc.; Wisconsin; Hybrid; USD 68,000 - 86,000; Full time

Benefits offered by this job

Healthcare Coverage

403B Retirement

Paid Holidays

Tuition Reimbursement

Parental Leave

EFAP

Pet Insurance

Onsite Fitness Facility

Discounted rates

Job summary

The Medical College of Wisconsin, Inc. is seeking a professional coder/billing specialist to perform CPT and ICD-10 coding, charge entry, and denial resolution.

You will collaborate with physicians, department administrators, and billing staff to ensure accurate reimbursements and compliant documentation. Responsibilities include processing professional service billings, reconciling charges, and providing provider education on coding policies.

Qualifications

• CPT and ICD-10 CM coding knowledge with modifiers.
• Experience with billing workflows and charge capture processes.
• Ability to resolve edits and denials in a timely manner.

Responsibilities

• Process CPT/ICD-10 coding and modifiers per documentation.
• Perform charge entry and reconcile charges across multiple departments.
• Identify and resolve claim denials and billing issues; liaise with staff and physicians.
• Provide provider education on coding policies and documentation trends.
• Develop and maintain protocols related to coding and billing areas.

Skills

CPT/ICD-10 coding

Charge entry & reconciliation

Interdepartmental communication

Detail oriented

Education

High School diploma

Coding certification (CPC/CCS-P) & RHIT/RHIA

Tools

EMR systems

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. 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.

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.

Benefits

• 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.

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. 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.