Coding Specialist IV - Clinical Practice Services

The Medical College of Wisconsin, Inc.; Wisconsin; Hybrid; USD 70,000 - 100,000; Full time

Benefits offered by this job

Healthcare coverage

Flexible spending options

403B retirement package

Paid vacation and holidays

Tuition reimbursement

Parental leave

Employee & Family Assistance Program

Pet Insurance

On campus fitness facility

Discounted rates (cell plans, etc)

Job summary

The Medical College of Wisconsin, Inc. is seeking an expert resource in documentation, coding, and billing to lead a multi-specialty team and ensure accurate charge capture and reimbursement.

You will train staff, supervise in the supervisor's absence, and drive coverage across specialties. Collaborate with physicians and administrators, resolve denials, and help develop protocols while supporting system testing and workflow improvements.

Qualifications

• High school diploma required.
• 5 years of related coding experience.
• CPC, CCS-P or RHIT/RHIA certifications preferred.

Responsibilities

• Charge processing and denial resolution across multispecialty coding.
• Guide staff in day-to-day coding and billing tasks.
• Train new and existing staff; provide cross-coverage.
• Identify and resolve reimbursement issues with physicians and admins.

Skills

Charge processing

CPT coding

ICD-10 CM coding

Team supervision

Training staff

Denials / billing issues

EMR systems

Education

High school diploma

CPC or CCS-P certification

RHIT or RHIA certification

Tools

EMR systems

Job description

Summary Serve as expert resource regarding all aspects of documentation, coding, and billing. Supports supervisor and team by guiding and directing specific employees in their day-to-day job functions. Train new and existing staff. Provide cross coverage for multiple specialty areas. Investigate and resolve issues pertaining to charge capture, billing, and reimbursement. Complete special projects as assigned. Act as supervisor in Supervisors’ absence. 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 Expert knowledge of multispecialty coding, which may include surgical, inpatient, emergency, and/or ambulatory coding; assignment or verification of CPT, ICD-10 CM coding and modifiers based upon documentation. Guide and direct specific employees in their day-to-day job functions. Answer questions and resolve coding and billing issues. Identify, report, and resolve coding and reimbursement issues with physicians, department administrators, and other billing office staff, including reimbursement staff. 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. Serve as a resource to staff for accurate assignment of CPT procedure and ICD-10-CM diagnosis coding of complicated multi-specialty services for appropriate reimbursement. Provide out of office coding coverage to multi-specialty areas.
• ASSIST WITH TEAM SUPERVISION AND SPECIAL PROJECTS Primary contact for staff when issues or questions arise. Monitor team workflow, assign and re-assign work to meet team and organizational goals. Quality review of staff work and workflows. Act as supervisor in Supervisor’s absence.
• TRAINING STAFF Onboarding/training of new or existing coding specialist staff.
• 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. Assist others in the development of protocols for other areas.
• SYSTEM TESTING Participate in system testing as needed.
• Knowledge – Skills – Abilities Expert knowledge of CPT, ICD-10 CM coding, payer, and governmental policies. Excellent oral and written communication skills. Detail oriented. Excellent presentation skills. Excellent project management and problem-solving skills. Ability to handle multiple issues at one time. 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: 5 years of related coding experience.
• Preferred Experience: Academic teaching institution professional billing experience.
• Required Certification/Licensure(s): Coding certification (CPC, CCS-P) and/or Health Information Management credential (RHIT, 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.

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 on a protected characteristic.

About Us

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.