Coding Specialist III - Clinical Practice Services

Summary 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 and their support staff and billing staff. Coordinates professional service billings for selected clinical departments. Assist in the analysis, development and implementation of new professional service lines related to coding, billing and charge capture. All remote work must be performed within one of the MCW registered payroll states, which currently includes: WI, AL, AZ, DE, FL, GA, IN, MD, MI, MN, MO, NC, TN, TX, & UT. Primary Responsibilities CHARGE PROCESSING: Assignment or verification of CPT, ICD-10 CM coding and modifiers based upon documentation. (Subject matter expert in a single specialty and/or crossed trained to cover multiple surgical/medical specialties for abstraction, ambulatory and/or surgical/procedural coding) 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. Knowledge of EMR’s and electronic charge workflows Serve as a resource to staff for accurate assignment of CPT procedure and ICD-10-CM diagnosis coding for single or multi-specialty services for appropriate reimbursement 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. Provide out of office coding coverage to other team members. Charge Entry as needed RECONCILIATION OF CHARGES: Monitor charge flow and act as a liaison with managers, department administrators and other billing personnel to assure consistent and accurate chage flow. Work with clinic staff and physicians regarding missing or unclear information that is required for billing CLAIM DENIALS /