Coding Quality Analyst
Medical College of Wisconsin · United States
- Hybrid
- Full-time
- $95,000 / year
- United States
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Job highlights
- Expert in multi-specialty coding and billing.
- Conducts coding audits and ensures compliance.
- Educates clinicians and coding staff.
- Analyzes denial trends and troubleshoots solutions.
- Requires coding certification and 6 years experience.
About the role
Job Summary
Serves as an expert resource for multi-specialty documentation, coding and billing. Assists in performing medical coding audits on clinicians and/or coding staff within multi-specialty physician practices to identify deficiencies and ensure coding compliance with guidelines and regulations. Responsible for 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 (WI, AZ, DE, FL, GA, IL, IN, MD, MI, MN, MO, NC, TN, TX, and UT).
Primary Responsibilities
- Acts as an expert resource for multi-specialty coding, charge capture, and reimbursement, including surgical, inpatient, emergency, and ambulatory coding. Assigns or verifies CPT, ICD-10 CM codes, and modifiers based on documentation.
- Participates in workgroups to evaluate, produce, and update policies and procedures related to internal processes for documentation, coding, and billing.
- Educates and trains new and existing employees in multi-specialty clinical areas on government documentation and coding regulations. Assists lead/CS IV team with educational sessions, including coding/charge capture processes and Epic-related changes.
- Onboards and educates new and existing physicians and APP’s on documentation and coding rules and regulations.
- Performs documentation and coding audits on clinicians and coding specialist staff to ensure coding accuracy.
- Supports the Charge Capture Team in analyzing coding denial trends and troubleshooting solutions, such as front-end system edits and front-end education, to minimize reimbursement delays.
- Assists in training coworkers, coding staff, and clinicians as appropriate, providing evaluation, education, and/or orientation adhering to CPT, ICD-10CM, and Government documentation and coding regulations.
- Serves as a Subject Matter Expert for Encoder Pro.
- Participates in new employee orientation to introduce them to the charge capture process.
- Maintains current knowledge of medical terminology, procedure codes, modifiers, diagnosis codes, coding requirements, and practices. Communicates changes to appropriate persons.
- Reviews 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 execution of various projects.
- Performs other duties or projects as assigned.
Knowledge – Skills – Abilities
- Ability to interact with people effectively.
- Expert knowledge of medical billing and collections revenue cycle as it relates to professional medical coding, reimbursement, contracting, and payment processing.
- Strong written and oral communication skills.
- Ability to take initiative, 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).
Key Skills/Competency
- Medical Coding
- CPT Codes
- ICD-10CM
- Auditing
- Compliance
- Revenue Cycle
- Epic
- Documentation
- Reimbursement
- Medical Terminology
Skills & topics
- Coding Quality Analyst
- Medical Coding
- CPT
- ICD-10CM
- Auditing
- Compliance
- Revenue Cycle
- Epic
- Documentation
- Reimbursement
- Healthcare
- Billing
- Physician Practices
- Remote Work
- Medical College of Wisconsin
How to get hired
- Tailor your resume: Highlight your experience with CPT, ICD-10CM, auditing, and Epic, aligning it with the Coding Quality Analyst role.
- Emphasize certifications: Clearly list your CPC, CCS-P, RHIT, or RHIA credentials, and relevant years of experience.
- Showcase expertise: Demonstrate your knowledge of medical billing, revenue cycle, and payer regulations in your application.
- Prepare for interviews: Be ready to discuss your problem-solving skills, communication abilities, and experience with coding tools like Encoder Pro.
Technical preparation
Master CPT, ICD-10CM, and modifier coding.,Practice performing coding audits on documentation.,Familiarize yourself with Epic and Encoder Pro.,Understand government and payer coding regulations.
Behavioral questions
Describe a time you educated staff on complex coding rules.,How do you handle conflicting coding guidelines?,Share an example of improving a process through auditing.,How do you prioritize multiple projects and deadlines?
Frequently asked questions
- What are the key coding certifications required for the Coding Quality Analyst position at Medical College of Wisconsin?
- For the Coding Quality Analyst role at Medical College of Wisconsin, you are required to have a coding certification such as CPC, CCS-P, or a Health Information Management credential like RHIT or RHIA. These certifications demonstrate your foundational knowledge and adherence to industry standards in medical coding.
- What experience is necessary to be considered for the Coding Quality Analyst job at Medical College of Wisconsin?
- The Medical College of Wisconsin requires a minimum of 6 years of experience for the Coding Quality Analyst position. Preferred experience includes front-end professional coding and familiarity with systems like Epic and Encoder Pro. An equivalent combination of education and experience may be considered.
- What is the remote work policy for the Coding Quality Analyst role at MCW?
- Remote work for the Coding Quality Analyst position at MCW is permitted, but all remote work must be performed within one of the MCW registered payroll states. These currently include WI, AZ, DE, FL, GA, IL, IN, MD, MI, MN, MO, NC, TN, TX, and UT.
- What technical skills are essential for a Coding Quality Analyst at Medical College of Wisconsin?
- Essential technical skills for a Coding Quality Analyst at Medical College of Wisconsin include proficiency in Excel and Word, a strong understanding of medical terminology, CPT, HCPCS, ICD-10CM coding, and CMS coding requirements. Experience with coding tools like Encoder Pro is also highly valued.
- How does the Medical College of Wisconsin ensure coding quality and compliance for its physicians and coding staff?
- The Medical College of Wisconsin ensures coding quality and compliance through regular medical coding audits performed by Coding Quality Analysts. These analysts identify deficiencies, provide education on coding guidelines and regulations, and support the Charge Capture Team in analyzing denial trends to improve accuracy and minimize reimbursement delays.