Coding Quality Analyst - Clinical Practice Services

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.

About the Role

Serves as an expert resource for multi-specialty documentation, coding, and billing. Assists 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.

Responsibilities

• Serve as an expert resource for 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 processes concerning documentation, coding, and billing.
• Educate and train new and existing employees in multispecialty clinical areas, including government documentation and coding regulations.
• Assist the lead/CS IV team in educational sessions, including coding/charge capture processes and Epic-related changes.
• Onboard and educate new and existing physicians and APPs on documentation and coding rules and regulations.
• Perform documentation and coding audits on clinicians and coding specialist staff for coding accuracy.
• Support the 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, and clinicians as appropriate to provide evaluation, education, and/or orientation adhering to CPT, ICD-10CM, and government documentation and coding regulations.
• Serve as a Subject Matter Expert for Encoder Pro.
• Participate 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; communicate 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 day-to-day prioritization and execution of various projects.
• Perform other duties or projects as assigned.

Requirements

• 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 exercise independent judgment, decision-making, and problem-solving skills.
• Proficient in Excel, 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.

Physical Requirements

• Work requires occasionally lifting moderate weight materials, standing, or walking continuously.
• Occasional exposure to dust, noise, temperature changes, or contact with water or other liquids.
• Work is performed in an environmentally controlled environment.
• Ability to detect and translate speech or other communication required; may occasionally require the ability to distinguish colors and perceive relative distances between objects.

Pay

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.

Benefits

• Outstanding healthcare coverage, including Health, Vision, and Dental, along with Flexible Spending options.
• 403B Retirement Package.
• Competitive Vacation and Paid Holidays.
• 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.

About MCW

At MCW, all endeavors—from internal operations to interactions with partners—are driven by shared organizational values: Caring, Collaborative, Curious, 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 realizing our vision of a healthier world, recognizing that a healthy and thriving community starts from within.