Coding Specialist II - Ophthalmology

Position Description:

As a Coding Specialist II, you will 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.

This role is 100% remote for the following states: WI, FL, MN, NC, TN, & TX.

Responsibilities:

CHARGE PROCESSING

• Assignment or verification of CPT, ICD-10 CM coding and modifiers based upon documentation. (Inpatient/Emergency Department abstraction, ambulatory coding and/or surgical/procedural coding)
• Resolve edits for electronic charges, following established policies and procedures to insure that 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 assure consistent and accurate charge flow. Work with clinic staff and physicians regarding missing or unclear information that is required for billing.

CLAIM DENIALS / BILLING ISSUES

• Identify, report, and resolve coding and reimbursement issues. Working 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.

PROVIDER EDUCATION

• Maintain understanding 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.

Knowledge - Skills - Abilities

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.

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: 2 year of related coding and/or health care experience

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

Preferred Qualifications:

Preferred Experience: Office experience; experience with Ophthalmology surgical coding, including familiarity with eye-related anatomy, terminology, and coding guidelines for procedures such as cataract, glaucoma, and retinal surgeries.

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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

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.

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