Coding Educator - Remote

ThedaCare • Neenah, WI

8d • Remote

About The Position

Summary : The Coder (Clinic - III) performs coding review for surgical specialties for ThedaCare Physician Services to accurately reflect services rendered. Reviews and processes charges using industry standard methodologies (CPT, ICD-10-CM, HCPCS), abides by Standards of Ethical Coding (AAPC/AHIMA), and complies with official coding guidelines and other regulatory requirements. Audits medical record documentation and educates providers on documentation improvement opportunities and risks. Educates and trains new team members to department standards. Mentors and observes team members in department responsibilities. Upholds and demonstrates department expectations and accuracy in regards to coding responsibilities including payer denials and claim edits.
Job Description: KEY ACCOUNTABILITIES: Reviews and/or assigns proper CPT procedures and/or diagnosis codes (ICD-10-CM including HCC risk adjustment diagnosis) for professional services including specialty medical services, in and outpatient E&M, and surgical procedures (i.e., cardiology, orthopedic, and general surgery) with a high degree of accuracy. Educates providers on documentation improvement opportunities. Conducts and reports internal documentation audits to ensure ThedaCare compliance by providers and team members. Performs internal reviews in response to third party data summaries and/or investigations. Creates mitigation plan to reduce future risk. Manages and maintains coding inventory responsibilities, internal reporting and payer denials, and claim edits to ensure timely reimbursement for services provided. Researches policy and communicates with payers. Mentors and trains team members to skills matrix requirements. Provides orientation training to new team members. Performs world class service to our customers, responding timely and professionally to inquiries. QUALIFICATIONS: High School diploma or GED preferred Must be 18 years of age Coding certificate or associate's degree in medical business or coding/health information Three years of experience in general medical or specialty coding Dual certifications through AAPC and/or AHIMA PHYSICAL DEMANDS: Ability to move freely (standing, stooping, walking, bending, pushing, and pulling) and lift up to a maximum of twenty-five (25) pounds without assistance Job classification is not exposed to blood borne pathogens (blood or bodily fluids) while performing job duties WORK ENVIRONMENT: Normally works in climate controlled office environment Frequent sitting with movement throughout office space Use of computers throughout the work day Frequent use of keyboard with repetitive motion of hands, wrists, and fingers

Requirements

• High School diploma or GED preferred
• Must be 18 years of age
• Coding certificate or associate's degree in medical business or coding/health information
• Three years of experience in general medical or specialty coding
• Dual certifications through AAPC and/or AHIMA
• Ability to move freely (standing, stooping, walking, bending, pushing, and pulling) and lift up to a maximum of twenty-five (25) pounds without assistance
• Job classification is not exposed to blood borne pathogens (blood or bodily fluids) while performing job duties
• Normally works in climate controlled office environment
• Frequent sitting with movement throughout office space
• Use of computers throughout the work day
• Frequent use of keyboard with repetitive motion of hands, wrists, and fingers

Responsibilities

• Reviews and/or assigns proper CPT procedures and/or diagnosis codes (ICD-10-CM including HCC risk adjustment diagnosis) for professional services including specialty medical services, in and outpatient E&M, and surgical procedures (i.e., cardiology, orthopedic, and general surgery) with a high degree of accuracy.
• Educates providers on documentation improvement opportunities.
• Conducts and reports internal documentation audits to ensure ThedaCare compliance by providers and team members.
• Performs internal reviews in response to third party data summaries and/or investigations.
• Creates mitigation plan to reduce future risk.
• Manages and maintains coding inventory responsibilities, internal reporting and payer denials, and claim edits to ensure timely reimbursement for services provided.
• Researches policy and communicates with payers.
• Mentors and trains team members to skills matrix requirements.
• Provides orientation training to new team members.
• Performs world class service to our customers, responding timely and professionally to inquiries.

Benefits

• Lifestyle Engagement e.g. health coaches, relaxation rooms, health focused apps (Wonder, Ripple), mental health support
• Access & Affordability e.g. minimal or zero copays, team member cost sharing premiums, daycare

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees