The Coding/QA Specialist supports the efficient and effective operations of the Dean Medical Group's Coding department. This support is provided for coding regulations, department workflows, system applications, revenue cycle improvement, system testing, building of test environments, verification of applications and working with the training department to assist with updated training materials. The Coding/QA Specialist works collaboratively with the WIITTS team and other business operations QA Specialists for all new systems that impact CPT, ICD and HCPCS codes. This position is also interfaces on a regular basis with the compliance and clinic departments for issue identification and resolution.
The Coding/QA Specialist is assigned a specific area or areas of the revenue cycle and concentrate their efforts by participating in the implementations of or upgrades to core business systems. This position is expected to lead and/or facilitate process design and redesign for departmental and cross departmental processes; lead and/or facilitate the completion of all projects within and outside the coding department and business office; develop and implement production tracking tools and reporting systems; provide day-to-day operational support to include issue identification, tracking, resolution and communication; perform functional assessments and time studies; develop and implement auditing systems. This position is responsible to automate as many coding guidelines/regulations and/or workflows as possible. The Coding QA Specialist also works to ensure all codes (CPT, ICD and HCPCS) appropriately split or are appended when automated, modifier application is correct and add-on codes are posted.
1) Lead and facilitate:
a) The implementations of or upgrades to core business systems by building the test scenarios, testing the scenarios, testing workflows, documenting options/recommendations and facilitating decision-making for the usage of these systems.
b) By performing end to end testing on all upgrades and new systems. Provide reports and summaries on the outcome(s). Make recommendations on options.
c) Reconciliation of charges for all upgrades and system implementations.
d) Process design and redesign for departmental and cross departmental workflows.
e) The completion of all projects within and outside the coding department, with business operations, compliance, clinic management, WIITTS and outside vendors as the project requires.
f) Multiple projects at the same time.
2) Develop, implement and maintain:
a) Checks and balances of automated processes, especially as they relate to CPT, ICD and HCPCS codes and related charges.
b) Automated possibilities for correct coding guidelines and regulations.
c) Production tracking and performance metric tools and reporting systems.
d) Issue tracking systems and provide solutions/options for issue identification, tracking, resolution and communication.
e) Coding training and workflow manuals, providing WIITTS with the information needed for the corporate training sections.
f) Effective reports to assess departmental output and results.
g) Functional assessments and time studies.
h) Charge auditing systems.
i) Staff audit systems.
j) A sound working relationship with the WIITTS team and clinic management to address upgrade changes that impact how codes are selected and posted to Resolute.
3) Evaluate and communicate:
a) Progress on issues, projects and operations to the coding/business office staff and management.
b) Process and workflow improvements on an ongoing basis to coding/business office staff and management.
c) Automated coding system changes to affected parties.
d) Information regarding participation in and status of meetings/work groups to impacted parties to ensure the proper transfer of knowledge of operational activities and assist with initial training on functions and workflow changes.
e) Future training needs to coding staff. Work with Director, Supervisor, training staff, and reporting staff to plan, develop, implement and evaluate quality assessment needs.
f) System barriers to impacted parties, making recommendations for system functionality changes, reporting issues, and training issues.
g) With the appropriate internal and external customers, vendors, and staff to ensure resolutions to barriers are developed and maintained while maintaining high customer service satisfaction.
h) Issues and resolution to issues to clinic management, providers and the compliance department.
i) Trends found through requesting and analyzing reports for coding or system issues to impacted parties.
4) Maintain Epic certification in any applications where certification was earned.
5) Performs other duties as assigned.
1. Bachelor's Degree in a business focused discipline with 2 years of relevant work experience OR an Associate Degree with 5-7 years of relevant work experience OR a high school diploma with 1 year of additional training/education and 7-9 years of relevant work experience OR a high school diploma with 10 years of relevant work experience.
2. Certification as a CPC, RHIT, RHIA, CPMA or CCS-P.
3. Knowledge and understanding of business operations and revenue cycle as it relates to use of tools, systems and interfaces for the proper application of codes.
4. Process improvement experience.
5. Experience with online coding tools, resources and websites such as AMA, CMS and EncoderPro.
6. Excellent verbal and written communication skills. Outstanding customer service skills.
7. Excellent analytical and organizational skills.
8. Experience and success in problem/issue identification, documentation, tracking and resolution.
9. Familiarity and experience with Microsoft Office Suite applications (Excel, Word, Power Point, Access, MS Project) or comparable products.
10. The ability to work well in a fast-paced, ever-changing team environment with multiple priorities.
1) Project Management experience or involvement on projects where formal project management techniques and tools were applied.
2) Experience with Epic Practice Management software.
3) Prior managerial or leadership experience.
Essential Physical Functions:
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.
1. Ability to sit for extended periods while on the phone or computer.
2. Ability to continuously see fine print and to use the computer for extended periods.
3. Ability to continuously perform fine motor tasks, such as computer, calculator, writing or phone tasks.
4. Ability to hear and converse on the phone and in person.
5. Ability to safely lift and to push/pull boxes or equipment weighing up to 20 pounds.
6. Ability to safely operate a personal vehicle on a weekly basis
About SSM Health Dean Clinic-
Based in Madison, Wis., Dean Clinic consists of a network of more than 60 clinics in south-central Wisconsin. Our more than 500 physicians provide primary, specialty and tertiary care in the clinics as well as eye care through our Davis Duehr Dean locations. Dean Clinic also offers urgent care services and operates outpatient surgery centers. Dean Clinic joined SSM Health in 2013.
You’ve known us as many names throughout St. Louis, and now, we’re bringing our hospitals, doctors, home care and other services together under one name – SSM Health. With seven hospitals, 350+ physicians, more than 40 physician locations and 12,000 employees, we are part of something bigger and better. We’re connected to a wealth of resources, expertise and advance technology to help you, your fa...mily and our community live long, healthy lives.
We’ve grown and changed a lot over our 143-year history. Our name may be changing but our mission remains the same