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Summary

The Certified Coding Specialist protects and recovers the clinic’s patient reimbursement by acting as a coding/billing resource for all MWU clinics, educating providers, monitoring accounts receivable, and collecting delinquent accounts. This position will report to the Assistant Manager of Patient Accounts.

Essential Duties and Responsibilities:

• Reviews coding used for Multispecialty Clinics and Eye Institute to ensure coding is in accordance with legal requirements, compliance standards, official coding rules, guidelines and definitions
• Review electronic health records (EHR) to determine what information is appropriate for coding purposes
• Participate in provider education on proper documentation of services provided, coding and billing issues, charge capture process and reconciliation of charges as it relates to E & M coding guidelines
• Train and educate finance staff on billing and coding
• Participate in clinic coding assessments/audits, both internal and with external vendors
• Participate in the development of coding policies and procedures as needed
• Identify key issues and take appropriate action to ensure revenue maximization on individual accounts
• Ensure all documentation (ABNs, letters of medical necessity, Medicare Wellness forms, etc.) are on file and properly filled out for patients when required
• Research coding/billing guidelines for new specialties
• Work in conjunction with the Assistant Manager and Manager of Patient Accounts to help reach and maintain financial and accounts receivable goals for the clinic
• Assist in implementing changes directed by regulatory agencies
• Maintain professional and technical knowledge by attending educational workshops, reviewing professional publications, and participating in professional organizations
• Other duties may be assigned

Supervisory Responsibilities                                                 

This position has no supervisory responsibilities.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Must be able to work in a constant state of alertness and safe manner and have regular, predictable, in-person attendance.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Other Qualifications

The position requires strict compliance with all policies and procedures.  This position requires a significant amount of interaction with the public and many internal customers and therefore, the individual must be able to develop positive rapport effectively.

Education and/or Experience              

High school diploma or GED required.  Associate degree preferred.  A minimum of 3-5 years of coding experience in a medical office setting and a current Certified Professional Coder (CPC) certification required.  Expert knowledge of ICD-10, CPT, HCPCS, modifiers, and medical terminology required.  Experience working with Medicare, Medicaid, Third party payers is also required.  Expert in interpreting LCD and NCD coverage criteria.  Knowledge of the revenue cycle, charge master, manual book coding/computer coding experience.  Excellent interpersonal, communication and customer service skills are required.  Strong analytical and problem solving skills.  Excellent verbal and written communication skills are a must.  Must be able to work independently and multi-task working on several projects at once.  

Computer Skills                                             

Computer proficiency in MS Office (Word, Excel, Outlook) is required.  Experience using medical practice management software is required. 

Language Skills                                             

Intermediate skills:  Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals.  Ability to write routine reports and correspondence.  Ability to speak effectively after groups of customers or employees of organization.

Reasoning Ability                                                      

Basic skills:  Ability apply common sense understanding to carry out detailed but uninvolved written or oral instructions.  Ability to deal with problems involving a few concrete variables in standardized situations.

Mathematical Ability

Basic skills:  Ability to add, subtract, multiply, and divide all units of measure using whole numbers, common fractions, and decimals.  Ability to compute rate, ratio, and percent and to interpret bar graphs. 

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 frequently required to sit, talk and hear.  The employee must regularly use hands to handle or feel and reach with hands and arms.  The employee is occasionally required to stand and walk.  The employee must frequently lift and /or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. 

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  The noise level in the work environment is usually moderate.

Midwestern University is a private, not-for-profit organization that provides graduate and post-graduate education in the health sciences. The University has two campuses, one in Downers Grove, Illinois and the other in Glendale, Arizona. More than 6,000 full-time students are enrolled in graduate programs in osteopathic medicine, dentistry, pharmacy, physician assistant studies, physical therapy, occupational therapy, nurse anesthesia, cardiovascular perfusion, podiatry, optometry, clinical psychology, speech language pathology, biomedical sciences and veterinary medicine. Over 500 full-time faculty members and 400 staff members are dedicated to the education and development of our students in an environment that encourages learning, respect for all members of the health care team, service, interdisciplinary scholarly activity, and personal growth.

We offer a comprehensive benefits package that includes medical, dental, and vision insurance plans as well as life insurance, short/long term disability and pet insurance.  We offer flexible spending accounts including healthcare reimbursement and child/dependent care account.  We offer a work life balance with competitive time off package including paid holiday’s, sick/flex days, personal days and vacation days.  We offer a 403(b) retirement plan, tuition reimbursement, child care subsidy reimbursement program, identity theft protection and an employee assistance program.  Wellness is important to us and we offer a wellness facility on-site with a fully equipped fitness facility. 

Midwestern University is an Equal Opportunity/Affirmative Action employer that does not discriminate against an employee or applicant based upon race; color; religion; creed; national origin or ancestry; ethnicity; sex (including pregnancy); gender (including gender expressions, gender identity; and sexual orientation); marital status; age; disability; citizenship; past, current, or prospective service in the uniformed services; genetic information; or any other protected class, in accord with all federal, state and local laws, and regulation. Midwestern University complies with the Smoke-Free Arizona Act (A.R.S. 36-601.01) and the Smoke Free Illinois Act (410 ILCS 82/).  Midwestern University complies with the Illinois Equal Pay Act of 2003 and Arizona Equal Pay Acts.

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