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.

Responsibilities

• Serve as an expert resource for multi-specialty documentation, coding, and billing.
• Assist in performing medical coding audits on clinicians and/or coding staff to identify deficiencies and ensure compliance with coding guidelines, government, and third-party payer regulations.
• Provide education and training for new and existing clinicians and coders, including team and/or clinical department educational sessions.
• Assign or verify CPT, ICD-10 CM coding, and modifiers based on documentation for surgical, inpatient, emergency, and/or ambulatory coding.
• Participate in workgroups to evaluate, produce, and/or update policies and procedures related to documentation, coding, and billing.
• 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 specialists for accuracy.
• Support the Charge Capture Team in analyzing coding denial trends and troubleshooting solutions, such as front-end system edits or education to minimize reimbursement delays.
• Train coworkers, coding staff, and clinicians on 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, and coding requirements; communicate changes to appropriate persons.
• Review payer policy publications, notices, and websites for coding and policy information to assist in appeal writing or support other action determinations.
• Prioritize and execute various projects on a day-to-day basis.
• Perform other duties or projects as assigned.

Requirements

• 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.

Skills

• Ability to interact with people effectively.
• Expert knowledge of medical billing and collections revenue cycle as it 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.

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.