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Job Title:
SHP Coding/Auditing Specialist (Remote-Hybrid)
Cost Center:
682891390 SHP-Strategic Finance
Scheduled Weekly Hours:
40
Employee Type:
Regular
Work Shift:
See Job Description for detail (United States of America)
Job Description:
JOB SUMMARY
The Coding/Auditing Specialist position conducts quality assurance activities to ensure the accuracy and integrity of risk adjustment data submitted to the Centers for Medicare & Medicaid Services (CMS) and Department of Health Services (DHS); identifies deficiencies and provides management with an analysis of outcomes and tools for improving accuracy in coding. This position is also responsible for auditing medical record documentation to determine appropriate diagnostic coding for services provided, taking into account the AMA CPT coding guidelines, ICD-9 & ICD-10 Coding Guidelines, CMS Medicare, HHS, and DHS BadgerCare Plus risk adjustment policy and Hierarchical Condition Category Coding.
JOB QUALIFICATIONS
EDUCATION
For positions requiring education beyond a high school diploma or equivalent, educational qualifications must be from an institution whose accreditation is recognized by the Council for Higher Education and Accreditation.
Minimum Required: High school graduate. Demonstrated knowledge of anatomy/physiology and medical terminology. Completion of courses in Current Procedural Terminology and , ICD-9 and ICD-10 coding required. Demonstrated knowledge of Word, Excel, and Access.
Preferred/Optional: Associate Degree in coding and/or health-related field.
EXPERIENCE
Minimum Required: Three years' experience in a health insurance, compliance, quality assurance, or auditing related position. Experience with ICD-9, ICD-10, CPT, HCC and HCPCS coding. Knowledge of the different CMS guidelines that affect Medicare Advantage, HHS-ACA and DHS/BadgerCare Plus members as related to revenue management.
Preferred/Optional: None
CERTIFICATIONS/LICENSES
The following licensure(s), certification(s), registration(s), etc., are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position.
Minimum Required: Certified Professional Coder and/or Certified Risk Adjustment Coder certification awarded by American Academy of Professional Coders is required within one year of hire.
Preferred/Optional: None
Given employment and/or payroll requirements of individual states, Marshfield Clinic Health System supports remote work in the following states:
Alabama
Kentucky
Oklahoma
Alaska
Michigan
South Carolina
Arkansas
Minnesota
South Dakota
Florida
Mississippi
Tennessee
Georgia
Missouri
Texas
Idaho
Nebraska
Utah
Illinois
North Carolina
West Virginia
Indiana
North Dakota
Wisconsin
Iowa
Ohio
Wyoming
Kansas
Marshfield Clinic Health System will not employ individuals living in states not listed above.
Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare. Successful applicants will listen, serve and put the needs of patients and customers first.
At Marshfield Clinic Health System, we are fully committed to addressing health equity, diversity and inclusion for our employees and providers, our patients, and the communities we serve. We believe that every individual should have the opportunity to attain their highest level of health. We embrace diversity and welcome differences in who we are and how we think. We believe that any individual or group should feel welcomed, respected and valued. View our Equity and Inclusion Statement here.
Exclusion From Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Health System's Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program.
Marshfield Clinic Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.
Job Title:
SHP Coding/Auditing Specialist (Remote-Hybrid)
Cost Center:
682891390 SHP-Strategic Finance
Scheduled Weekly Hours:
40
Employee Type:
Regular
Work Shift:
See Job Description for detail (United States of America)
Job Description:
JOB SUMMARY
The Coding/Auditing Specialist position conducts quality assurance activities to ensure the accuracy and integrity of risk adjustment data submitted to the Centers for Medicare & Medicaid Services (CMS) and Department of Health Services (DHS); identifies deficiencies and provides management with an analysis of outcomes and tools for improving accuracy in coding. This position is also responsible for auditing medical record documentation to determine appropriate diagnostic coding for services provided, taking into account the AMA CPT coding guidelines, ICD-9 & ICD-10 Coding Guidelines, CMS Medicare, HHS, and DHS BadgerCare Plus risk adjustment policy and Hierarchical Condition Category Coding.
JOB QUALIFICATIONS
EDUCATION
For positions requiring education beyond a high school diploma or equivalent, educational qualifications must be from an institution whose accreditation is recognized by the Council for Higher Education and Accreditation.
Minimum Required: High school graduate. Demonstrated knowledge of anatomy/physiology and medical terminology. Completion of courses in Current Procedural Terminology and , ICD-9 and ICD-10 coding required. Demonstrated knowledge of Word, Excel, and Access.
Preferred/Optional: Associate Degree in coding and/or health-related field.
EXPERIENCE
Minimum Required: Three years' experience in a health insurance, compliance, quality assurance, or auditing related position. Experience with ICD-9, ICD-10, CPT, HCC and HCPCS coding. Knowledge of the different CMS guidelines that affect Medicare Advantage, HHS-ACA and DHS/BadgerCare Plus members as related to revenue management.
Preferred/Optional: None
CERTIFICATIONS/LICENSES
The following licensure(s), certification(s), registration(s), etc., are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position.
Minimum Required: Certified Professional Coder and/or Certified Risk Adjustment Coder certification awarded by American Academy of Professional Coders is required within one year of hire.
Preferred/Optional: None
Given employment and/or payroll requirements of individual states, Marshfield Clinic Health System supports remote work in the following states:
Alabama
Kentucky
Oklahoma
Alaska
Michigan
South Carolina
Arkansas
Minnesota
South Dakota
Florida
Mississippi
Tennessee
Georgia
Missouri
Texas
Idaho
Nebraska
Utah
Illinois
North Carolina
West Virginia
Indiana
North Dakota
Wisconsin
Iowa
Ohio
Wyoming
Kansas
Marshfield Clinic Health System will not employ individuals living in states not listed above.
Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare. Successful applicants will listen, serve and put the needs of patients and customers first.
At Marshfield Clinic Health System, we are fully committed to addressing health equity, diversity and inclusion for our employees and providers, our patients, and the communities we serve. We believe that every individual should have the opportunity to attain their highest level of health. We embrace diversity and welcome differences in who we are and how we think. We believe that any individual or group should feel welcomed, respected and valued. View our Equity and Inclusion Statement here.
Exclusion From Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Health System's Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program.
Marshfield Clinic Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.
