Wisconsin Licensed Coding Specialist
Job Summary
To ensure accurate and compliant claims processing, the full-time Senior Coding Compliance Specialist will investigate coding guidelines, analyze billing trends, and collaborate with teams to enhance payment integrity while working onsite in Wisconsin.
Key responsibilities
- Research and validate business decisions and system rationales to support edits and conduct testing to validate outcomes
- Analyze billing and coding patterns, identifying outliers with potentially high-risk practices
- Review and resolve appeals by analyzing medical documentation and collaborating with Clinical Services teams as needed
Required qualifications
- Associate's degree in medical coding with 5+ years of medical coding experience, or high school equivalency with 8+ years of medical coding experience
- Completion of a medical coding program and certification in CPC, COC, RHIT, RHIA, CCA, and/or CCS
- Strong working knowledge of medical coding and regulatory guidelines, including CPT, HCPCS, ICD-10, OPPS, IPPS, and DRGs
- Experience with Epic healthcare software and/or Optum claims edit systems
- Knowledge of governmental medical payment policies/regulations and HIPAA regulations
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