Coding Specialist IV

Position Description:

Every day, in ways both big and small, the Medical College of Wisconsin (MCW) is impacting lives for the better. MCW ... changemaking for a healthier Wisconsin.

In the role of Coding Specialist IV, you will be working in the Clinical Practice Services department. You will serve as expert resource regarding all aspects of documentation, coding, and billing. Support 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.

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.
• Work 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.

Preferred Schedule:



Full-time role with expectations for coverage during core business hours and flexibility required as necessary to accommodate business needs.

Position Requirements:

Minimum Qualifications:

Appropriate experience may be substituted for education on an equivalent basis.

Minimum Required Education: High school graduate or equivalent

Minimum Required Experience: 5 years of related experience in a multi-specialty physician practice plan, coding multiple medical/surgical specialties/subspecialties.

Certification: Coding certification (CPC, CPC-A, CCS-P, or CCA) and/or health information management credential (RHIT or RHIA).

Preferred Qualifications:

Preferred Experience: Academic teaching institution professional billing experience.

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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
• 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.

For a full list of positions see: www.mcw.edu/careers

For a brief overview of our benefits see: https://www.mcw.edu/departments/human-resources/benefits

Eastern Wisconsin is a vibrant, diverse metropolitan area. MCW is intent on attracting, developing, and retaining a diverse workforce and faculty body that reflects the community we serve. We value diversity of backgrounds, experience, thought, and perspectives to advance excellence in science and medicine. MCW is a welcoming campus community with a strong culture of collaboration, partnership, and engagement with our surrounding community. For more information, please visit our institutional website at https://www.mcw.edu/departments/office-of-diversity-and-inclusion.

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 a diverse 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 upon a protected characteristic.

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