ProFee Inpatient Coding Specialist III - REMOTE

cwi; United States; Remote; USD 65,000 - 90,000; Full time

Job summary

Children's Wisconsin is seeking a 100% remote Pro-Fee Inpatient Coding Specialist III to code, review and release charges with accuracy and compliance. The role collaborates with physicians and departments to ensure proper charge capture and adherence to coding guidelines.

Ideal candidates have 3 years of inpatient Pro-Fee coding experience, NICU exposure preferred, and familiarity with EHR systems. Certifications listed support expertise in this field.

Qualifications

• Knowledge of ICD10, CPT and HCPCS coding guidelines.
• Experience with an Electronic Health Record (EHR).
• Epic experience preferred.

Responsibilities

• Assigns or verifies CPT, ICD-10 CM coding and modifiers based on documentation.
• Resolves edits for various charges, following established policies and procedures.
• Monitors charge capture volumes and work queues; acts as a resource for leaders and staff.
• Queries Providers as needed and coordinates responses to Provider questions.
• Uses coding knowledge to identify trends and educational opportunities for Providers and staff.
• Identifies opportunities to reduce denials.

Skills

Communication skills

Independent work

Problem solving

Education

High School diploma / GED / HSED

Tools

Epic experience

Job description

At Children's Wisconsin, we believe kids deserve the best.

Children's Wisconsin is a nationally recognized health system dedicated solely to the health and well‑being of children. We provide primary care, specialty care, urgent care, emergency care, community health services, foster and adoption services, child and family counseling, child advocacy services and family resource centers. Our reputation draws patients and families from around the country.

We offer a wide variety of rewarding career opportunities and are seeking individuals dedicated to helping us achieve our vision of the healthiest kids in the country. If you want to work for an organization that makes a difference for children and families, and encourages you to be at your best every day,

Please follow this link for a closer look at what it's like to work at Children's Wisconsin: https://www.instagram.com/lifeatcw/

The ProFee Inpatient Coding Specialist III will work in collaboration with Ancillary or specialty departments/locations/providers to code, review and release charges in a timely manner and to ensure correct coding, billing compliance and complete charge capture. Collaborates with providers and other departmental staff/leaders on coding or charge capture related questions/topics.

100% Remote

Full time: Monday-Friday (40 hrs per week)

Experience:

• Three years of experience coding Pro-Fee Inpatient E/M services for multi-specialty required
• NICU experience preferred
• Experience coding bedside procedures in the inpatient setting
• Experience working claim edits and denials
• Epic experience preferred

Licenses and Certifications:

One of the following:

• CPC-Certified Professional Coder - American Board of Professional Coders
• CCS-P-Certified Coding Specialist Physician Based - American Health Information Management Association
• CCS-Certified Coding Specialist - American Health Information Management Association
• RHIT-Registered Health Information Technician - American Health Information Management Association

Education:

High School graduate or Certificate of General Educational Development (GED) or High School Equivalency Diploma (HSED) required.

Knowledge, Skills and Abilities:

• Knowledge of ICD10, CPT and HCPCS coding guidelines.
• Working knowledge of CCI edits, healthcare insurance guidelines and other regulatory guidance.
• Prior use of an Electronic Health Record.
• Excellent communication (oral and written) skills.
• Ability to work independently, exercise independent judgment and solve problems effectively.
• Specialty Coding knowledge.

Essential Duties:

• Ability to work independently, exercise independent judgment and solve problems effectively.
• Specialty Coding knowledge.
• Assigns or verifies CPT, ICD-10 CM coding and modifiers based upon documentation. Subject matter expert in one or more specialties and may also cover multiple surgical/medical specialties for abstraction, ambulatory and/or surgical/procedural coding. Ensures compliance with official coding guidelines.
• Resolves edits for various charges, following established policies and procedures to insure that all data elements are applied.
• Monitors charge capture volumes and work queues and acts as a resource for department leaders and administrators, clinical staff and other revenue cycle staff to assure consistent and accurate charge capture. Works with clinic staff and Providers regarding missing or unclear information that is required for billing.
• Queries Providers as needed and coordinates responses to Provider questions.
• Uses coding knowledge to identify trends and educational opportunities for Providers and other staff.
• Identifies opportunities to reduce denials.
• Develops and maintains all protocols and processes related to assigned areas of responsibility.
• Maintains understanding all teaching Physician and Provider documentation policies.
• May train other Coders on new departments or specialties.

Children's Wisconsin is an equal opportunity / affirmative action employer. We are committed to creating a diverse and inclusive environment for all employees. We treat everyone with dignity, respect, and fairness. We do not discriminate against any person on the basis of race, color, religion, sex, gender, gender identity and/or expression, sexual orientation, national origin, age, disability, veteran status, or any other status or condition protected by the law.

Certifications/Licenses:

+ one of the following: - N/A, CCS-Certified Coding Specialist - American Health Information Management Association, CCS-P-Certified Coding Specialist Physician Based - American Health Information Management Association, CPC-Certified Professional Coder - American Board of Professional Coders, RHIT-Registered Health Information Technician - American Health Information Management Association