Coder; Clinic - III

Living A Life Inspired! Our new vision at Theda Care 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 Theda Care, 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 Theda Care.

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 Theda Care! Summary :
The Coder (Clinic - III) performs coding review for surgical specialties for Theda Care 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.

• 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 Theda Care 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.

• 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

• 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

• Normally…