Coder (Clinic - III)

Why ThedaCare?

Living A Life Inspired! Our new vision at ThedaCare is bold, ambitious, and ignited by a shared passion to provide outstanding care. We are inspired to reinvent health care by becoming a proactive partner in health, enriching the lives of all and creating value in everything we do. Each of us are called to take action in delivering higher standards of care, lower costs and a healthier future for our patients, our families, our communities and our world. At ThedaCare, our team members are empowered to be the catalyst of change through our values of compassion, excellence, leadership, innovation, and agility. A career means much more than excellent compensation and benefits. Our team members are supported by continued opportunities for learning and development, accessible and transparent leadership, and a commitment to work/life balance. If you’re interested in joining a health care system that is changing the face of care and well-being in our community, we encourage you to explore a future with ThedaCare.

Benefits, with a whole-person approach to wellness – Lifestyle Engagement e.g. health coaches, relaxation rooms, health focused apps (Wonder, Ripple), mental health support Access & Affordability e.g. minimal or zero copays, team member cost sharing premiums, daycare.

About ThedaCare! Summary : 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.

Job Description:

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

PHYSICAL DEMANDS:

• Ability to move freely (standing, stooping, walking, bending, pushing, and pulling) and lift up to a maximum of twenty-five (25) pounds without assistance
• Job classification is not exposed to blood borne pathogens (blood or bodily fluids) while performing job duties

WORK ENVIRONMENT:

• Normally works in climate controlled office environment
• Frequent sitting with movement throughout office space
• Use of computers throughout the work day
• Frequent use of keyboard with repetitive motion of hands, wrists, and fingers

Scheduled Weekly Hours: 40

Scheduled FTE: 1

Location: CIN 3 Neenah Center - Appleton,Wisconsin

Overtime Exempt: No

Worker Shift Details:

About ThedaCare

ThedaCare is a community health system consisting of seven hospitals, numerous clinics and related services.We are the third largest health care employer in Wisconsin and the largest employer in the state's second largest economic market - Northeast Wisconsin - with approximately 6,800 employees. Through our 100-year history, ThedaCare has woven itself into the very fabric of the communities we serve. For our employees, ThedaCare offers an environment that not only welcomes but also encourages innovative thinking and fresh approaches to today’s health care challenges. We’ve improved the health of thousands of individuals. We know this because we track our quality and constantly seek to improve our care and services for the members of our communities.

This job posting is available in other languages besides English free of charge.

ThedaCare is an Equal Opportunity Employer.

ThedaCare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, ancestry, color, religion, sex, gender identity, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.