Inpatient Coding Quality Reviewer Jobs in Wisconsin

• Directs teams conducting formal audits of facility coding practices, coding documentation, and coding accuracy to identify areas for improvement and ensure compliance with coding regulations and directs team conducting prospective reviews prior to billing to ensure accuracy and to avoid denials.
• Collaborate with other Mid-Revenue Cycle Integrity leaders and relevant key stakeholders such as Compliance, Internal Audit, and Billing, Quality, and CDI to address coding-related issues and promote cross-departmental cooperation as appropriate.
• In collaboration with leader, communicate coding quality and audit findings, recommendations, and initiatives to senior Integrity leadership.
• Provide daily direction and guidance to the coding quality and audit team to meet assigned goals and to support continuous improvement efforts.
• Monitor key performance indicators (KPIs) and metrics related to facility coding quality, audit outcomes, productivity, and compliance.
• Prepare information for regular reports summarizing facility coding quality and audit findings, trends, and progress toward goals for senior Integrity leadership and regulatory reporting purposes.

Major Responsibilities:

• Supervises the timely, accurate review and validation of charges/codes assigned for billing. This includes charge review; claim edit and insurance rejections. At times, it may also include customer concerns that question coding. Ensures that coding practices and quality are consistent with coding and other regulatory requirements.
• Supervises highly functioning, self-directed work teams.
• Maintains up-to-date knowledge of Medicare, Medicaid and other regulatory requirements pertaining to nationally accepted coding policies and standards. Develops expertise in coding for assigned responsibilities.
• Oversees the Epic coding functions for all types of charges/codes coding production is responsible for to ensure that claims are submitted to payers in compliance with coding regulations and organizational guidelines.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines. Practices ethical judgment in assigning and sequencing codes for proper insurance reimbursement.
• Reports inconsistent processes systemwide. Documents all coding procedures and guidelines in writing and ensures all coding team members adhere to them. Identifies opportunities for process and quality improvement.
• Works directly with the Coding leadership to research and resolve issues.
• Ensures that documentation, coding procedures and requirements are clearly communicated and enforced to coding staff.
• Communicates and reinforces changes in CPT, ICD, HCPCS and other requirements and coordinates necessary modifications and updates to appropriate coding staff.
• Develop and updates department guidelines and procedures. Educate team members on coding related guidelines, procedures and practices.
• Identifies trends and report recommended resolution to charge capture, coding and billing issues and rejections.
• Performs human resources responsibilities for staff which includes coaching on performance, completes performance reviews and overall staff morale. Recommends hiring, compensation changes, promotions, corrective action decisions, and terminations.
• Responsible for understanding and adhering to the organizations Code of Ethical Conduct and for ensuring that personal actions, and the actions of employees supervised, comply with the policies, regulations and laws applicable to Advocate Aurora's business.

Licensure, Registration, and/or Certification Required:

• Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or American Health Information Management Association (AHIMA)

Education Required:

• Bachelors degree (or equivalent knowledge) in Health Information Management or related field.

Experience Required:

• 5 years of experience in professional coding that includes experiences in advanced level of ICD, CPT and HCPCS professional coding in a large, complex clinic or hospital setting at a lead or senior level. Requires 1 year of progressive leadership experience in a high-volume health care setting.

Knowledge, Skills & Abilities Required:

• Demonstrated leadership skills and abilities including team building, conflict resolution, project management and effective decision making.
• Expert knowledge of ICD, CPT and HCPCS coding guidelines. Advanced knowledge of medical terminology, anatomy and physiology.
• Knowledge of Medicare, Medicaid and commercial payer coding guidelines.
• Advanced computer skills including the use of Microsoft office products, especially Excel, electronic mail, including experience with electronic coding systems or applications.
• Advanced communication (oral and written), presentation and interpersonal skills, including the ability to effectively collaborate with multiple departments.
• Advanced organization and prioritization skills; ability to manage multiple priorities in a stressful, fast-paced work environment.
• Ability to work independently and exercise independent judgment and decision making.
• Ability to meet deadlines while working in a fast-paced environment.
• Ability to take initiative and work collaboratively with others.

Physical Requirements and Working Conditions:

• Exposed to a normal office environment.
• Must be able to sit for extended periods of time.
• Must be able to continuously concentrate.
• Position may be required to travel to other sites; therefore, may be exposed to road and weather hazards.
• Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Pay Range

Our CommitmenttoYou:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, andShort- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program