Coding Quality Analyst

Summary

Serves as an expert resource for multi-specialty documentation, coding and billing. Assist 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 and guidelines.  Responsible for new and existing clinician and coder education, as well as team and/or clinical department educational sessions. 

All remote work must be performed within one of the MCW registered payroll states, which currently includes: WI, AZ, DE, FL, GA, IL, IN, MD, MI, MN, MO, NC, TN, TX, and UT.

Primary Responsibilities

• Expert resource of 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 process in relation to documentation, coding, and billing.

• Educate/train new and existing employees in multispecialty clinical areas, include government documentation and coding regulations. Assist lead/CS IV team in educational session, include coding/charge capture process and Epic related changes.

• Onboard/educate new and existing physicians and APP’s on documentation and coding rules and regulations.

• Perform documentation and coding audits on clinicians and coding specialist staff for coding accuracy. 

• Support 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, clinicians as appropriate to provide evaluation, education and/or orientation adhering to CPT, ICD-10CM and Government documentation and coding regulations.

• Subject Matter Expert for Encoder Pro.

• Participates 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. Communicates 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 the day-to-day prioritization and the execution of various projects.

• Perform other duties or projects as assigned.

• Other duties as assigned.

Knowledge – Skills – Abilities

• 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 to exercise independent judgment, decision making and problem-solving skills.

• Proficient in Excel and 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

Preferred Experience:  Front end professional coding, Epic, Encoder Pro

Required Certification/Licensure(s): Coding certification (CPC, CCS-P) and/or Health Information Management credential (RHIT, RHIA).

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Physical Requirements

Work requires occasionally lifting moderate weight materials, standing, or walking continuously.

Work Environment

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.

Target salary range for this position is between $74,500.00 and $94,900.00 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.

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

• 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 etc.

For a brief overview of our benefits see: Benefits Overview

For a full list of positions see: MCW Careers

At MCW all of our endeavors, from our internal operations to our interactions with our partners, are driven by our shared organizational values: Caring – Collaborative – Curiosity – 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 realize our vision of a healthier world, and we recognize that a healthy and thriving community starts from within. Our values define who we are, what we stand for and how we conduct ourselves at MCW. If you believe in embracing individuality and working together according to these principles to improve health for all, then MCW is the place for you. For more information, please visit our institutional website.

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 an inclusive 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.