Full-time, day shift, on-site role at Crossing Rivers Health in Prairie du Chien, Wisconsin.
The Medical Coding and Prior Authorization Specialist plays a dual role in supporting accurate clinical documentation and ensuring timely authorization of services for patients. This position is responsible for coding assigned encounter types, reviewing and correcting coding-related denials, and managing prior authorization processes for specialty services, surgical procedures, therapies, and imaging.
The goal of this role is to support compliance, maximize reimbursement, and ensure patients have timely access to medically necessary care.
Essential Job Functions
- Review clinical documentation to ensure coding accuracy, completeness, and compliance with regulations.
- Assign diagnosis, procedural, and treatment codes for patient encounters using ICD-10-CM, ICD-10-PCS, CPT, HCPCS, and related guidelines.
- Apply knowledge of modifier usage, CCI edits, and LCD/NCD regulations.
- Perform data entry, verification, and proper sequencing in the electronic health record.
- Submit provider queries following approved guidelines.
- Identify and resolve clinical documentation and charge capture discrepancies.
- Initiate and manage prior authorization requests for surgical procedures, specialty services, imaging, and rehabilitation therapies.
- Verify medical necessity and payer-specific criteria before submitting authorization requests.
- Assist with denial follow-up and appeals related to coding or prior authorization.
- Collaborate with providers, nursing staff, and scheduling teams to obtain required documentation.
- Monitor pending authorizations and communicate with payers, providers, and patients as needed.
- Track and report trends in authorization denials and coding discrepancies.
- Support provider and staff education on documentation and authorization best practices.
- Contribute to continuous improvement and patient-centered service.
Requirements & Qualifications
- High school diploma or GED required.
- Associate degree in Health Information Management, Medical Coding, or a related medical coding diploma/program required.
- Registered Health Information Technician or related medical coding certification within 6 months of hire.
- 2+ years of medical coding experience in a Critical Access Hospital or similar setting preferred.
- Prior authorization and insurance verification experience preferred.
- Proficiency in Microsoft Office required.
- Epic experience preferred.
Benefits & Perks
- Competitive pay
- Medical insurance
- Dental insurance
- Vision insurance
- Life insurance
- Short-term disability
- Paid time off
- Retirement plan with company match
- Relocation incentive opportunity for eligible out-of-state households
Location
Wisconsin, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 month ago