Aspirus Health

• Utilize available encoder, grouper software, and other coding resources to determine the appropriate ICD-10-CM, CPT, and/or HCPCS including specialty specific codes and Evaluation and Management (E&M) codes • Maintain an understanding and apply knowledge of National Correct Coding Initiatives (NCCI), Local Coverage Documents and National Coverage Documents (LCD/NCD) directives, Medically Unlikely Edits (MUEs), and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory requirements and institutional guidelines to select appropriate codes and modifiers

• Work closely with UW Health Specialty Clinics to identify pertinent patient information to assist in the scheduling, ambulatory access, and pre-visit planning processes • Collaborate to optimize workflows around record gathering and abstraction, streamlining the prior authorization process, and optimizing use of electronic medical records • Utilize electronic medical record (EMR) functionalities and Access Database to coordinate record retrieval from external providers

• Utilize available encoder, grouper software, and other coding resources to determine the appropriate ICD-10-CM, CPT, and/or HCPCS including specialty specific codes and Evaluation and Management (E&M) codes • Maintain an understanding and apply knowledge of National Correct Coding Initiatives (NCCI), Local Coverage Documents and National Coverage Documents (LCD/NCD) directives, Medically Unlikely Edits (MUEs), and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory requirements and institutional guidelines to select appropriate codes and modifiers

• Utilize available encoder, grouper software, and other coding resources to determine the appropriate ICD-10-CM, CPT, and/or HCPCS including specialty specific codes and Evaluation and Management (E&M) codes. • Maintain an understanding and apply knowledge of National Correct Coding Initiatives (NCCI), Local Coverage Documents and National Coverage Documents (LCD/NCD) directives, Medically Unlikely Edits (MUEs), and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory requirements and institutional guidelines to select appropriate codes and modifiers.

• Audit high risk reimbursement issues for both professional and facility billing across all of UW Health (Madison, Northern Illinois, and joint ventures). • Utilize in depth knowledge of CPT/ICD10 coding to assess, research, educate, and problem solve complex issues/questions. • Work with key stakeholders across the organization on projects and actively participate in meetings/workgroups. • Ability to be proficient in data analytics programs, systems, and databases to identify risks and track audit findings. • Responsible for compliance audits of billing providers and facilities

• Provide coaching to coding staff and ensure employees are receiving feedback on areas for improvement • Collaborate with Clinical Documentation Improvement (CDI) on Hierarchical Condition Category (HCC) Coding • Participate in hiring efforts which includes interviewing, onboarding, and training • Coordinate staffing schedules to ensure quality and production standards are being met

• Utilize available encoder, grouper software, and other coding resources to determine the appropriate ICD-10-CM, CPT, and/or HCPCS including specialty specific codes and Evaluation and Management (E&M) codes • Maintain an understanding and apply knowledge of National Correct Coding Initiatives (NCCI), Local Coverage Documents and National Coverage Documents (LCD/NCD) directives, Medically Unlikely Edits (MUEs), and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory requirements and institutional guidelines to select appropriate codes and modifiers

• Utilize available encoder, grouper software, and other coding resources to determine the appropriate ICD-10-CM, CPT, and/or HCPCS including specialty specific codes and Evaluation and Management (E&M) codes. • Maintain an understanding and apply knowledge of National Correct Coding Initiatives (NCCI), Local Coverage Documents and National Coverage Documents (LCD/NCD) directives, Medically Unlikely Edits (MUEs), and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory requirements and institutional guidelines to select appropriate codes and modifiers.

• Perform Medicare coverage analysis and participation in ancillary service reviews along with assistance in research study activations within HealthLink (EPIC) • Review all charges related to clinical trials to ensure Medicare coverage rules and clinical trial contracts are adhered to • Serve as the primary point of contact and technical expert for complex research billing workflows, including providing ongoing updates, training, and involvement in research-related IT projects • Collaborate and build strong working relationship with clinical research departments and clinical research compliance

• Utilize available encoder, grouper software, and other coding resources to determine appropriate ICD-10-CM, CPT, and/or HCPCS including specialty specific codes and Evaluation and Management (E&M) codes. • Maintain understanding and apply knowledge of National Correct Coding Initiatives (NCCI), Local Coverage Documents and National Coverage Documents (LCD/NCD) directives, Medically Unlikely Edits (MUEs), and Medicare Teaching Physician Guidelines. • Resolve payer denials and respond to inquiries from revenue cycle teams, processing charge corrections as appropriate.