Summary: The Coding Specialist is responsible for correctly coding both the CPT and ICD codes to healthcare claims in order to obtain reimbursement from commercial and government insurance companies. This position is working in our Westwood location in Wausau with the possibility of remote work upon successful completion of training and business needs.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

1. Maintains comprehensive understanding of coding rules and guidelines in order to facilitate ongoing communication and policies with internal staff.
2. Maintains a thorough understanding of anatomy and physiology, medical terminology, disease processes and surgical techniques through participation in continuing education programs to effectively apply ICD-9/ICD-10 and CPT-4 coding guidelines.
3. Facilitate appropriate clinical and operative report documentation to ensure that level of services and acuity of conditions are accurately reflected in the medical records through extensive interaction with physician's, advanced practice providers, clinical staff, and coding staff.
4. Route operative/procedure/ER/Consultation reports to internal/external coding vendors.
5. Coordinates with the HIM Workflow Specialist to ensure that all external operative notes and ER/Consult visits are received.
6. Creates encounters for all ER/Consultation visits and other non-scheduled visits and surgeries.
7. Codes from final surgical/procedural operative reports and/or office note signed by the provider and file charges to appropriate insurance carriers and/or reviews and verifies coding and billing for external coding vendors.
8. Educate internal staff on clinical documentation needs, changes to clinical documentation guidelines and coding and reimbursement issues.
9. Assist in the planning, education and training for CPT and ICD 10 code assignment for all necessary staff.
10. Works directly with Coding Team Lead/Revenue Cycle Supervisor to identify documentation issues to optimize physician coding practices for compliance and revenue purposes.
11. Assists with the appeals process for insurance denials of surgical/procedural services.
12. Special projects as assigned.

Education/Experience:

1. High school diploma or equivalent, required.
2. Minimum of three years medical coding experience, preferred
3. Strong broad based clinical knowledge and understanding of pathology/physiology of disease processes, preferred
4. Current knowledge of reimbursement and coding structures (specifically Medicare and Medicaid)

Qualifications:

1. Credentialed Coder Certificate (CPC, CCS, CPMA, CCDS, RHIT, RHIA), preferred.
2. Experience with electronic medical records or electronic health records (EMR or EHR) system, preferred
3. Microsoft Excel and Word experience, preferred.
4. Ability to make sound judgments according to procedures or acceptable recommendations for exceptions when needed.
5. Confidence and ability to work with Clinical Staff and Physicians.
6. Excellent interpersonal skills to build effective partnering relationships with internal departments.
7. Excellent communications skills both written and verbal.
8. Valid WI Driver's License

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to talk and hear. The employee frequently is required to stand; walk; sit; use hands to type; and reach with hands and arms. The employee is occasionally required to stoop, kneel, crouch and bend. The employee must occasionally lift and/or move boxes up to 20 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus. Essential Physical Requirements All responses use the following codes: N = Never O = Occasional, represents 1 to 33% or 1 to 2 hours of an 8 hour workday. F = Frequently, represents 34 to 66% or 2 to 5 hours of an 8 hour workday. C = Continuously, represents 67 to 100% or 6 to 8 hours of an 8 hour workday.

Physical Ability (Acceptable Minimum):

Vision: Good

Color Vision: Normal

Hearing: Normal

Manual Dexterity: Good

Talking/ Speech: Good