Coding Specialist II

Summary of role: 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, their support staff, and billing staff. Coordinates professional service billings for selected clinical departments.

Responsibilities

• Charge Processing: Assign or verify CPT, ICD-10 CM coding and modifiers based on documentation (inpatient/emergency department abstraction, ambulatory coding, and/or surgical/procedural coding). Resolve edits for electronic charges following established policies to ensure all data elements (claim requirements – CPT, ICD-10 CM, modifiers, provider, billing area, etc.) are applied.
• Charge entry as needed.
• Reconciliation of Charges: Monitor charge flow and act as a liaison with managers, department administrators, and other billing personnel to ensure consistent and accurate charge flow. Work with clinic staff and physicians regarding missing or unclear information required for billing.
• Claim Denials / Billing Issues: Identify, report, and resolve coding and reimbursement issues. Collaborate 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 assigned areas.
• Provider Education: Maintain understanding of 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.

Qualifications

• Appropriate experience may be substituted for education on an equivalent basis.
• Minimum Required Education: High school graduate or equivalent.
• Minimum Required Experience: 2 years of related coding and/or health care experience.
• Required Certification/Licensure(s): Coding certification (CPC, CPC-A, CCS-P, or CCA) and/or Health Information Management credential (RHIT or RHIA).
• Preferred Experience: Office experience.

Skills

• Working knowledge of CPT and ICD-10 CM coding.
• Understanding of medical insurance guidelines and governmental policies.
• Progressive computer skills.
• Detail-oriented.
• Ability to establish and maintain effective working relationships with the team and department staff (including administrative staff and faculty).
• Meet or exceed established production rate and performance standards.

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.
• 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 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 select cell phone plans, local fitness facilities, Milwaukee recreation, and entertainment.