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

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