Wisconsin Licensed Coding Specialist

To ensure accurate and compliant claims processing, the full-time Senior Coding Compliance Specialist will investigate coding guidelines, analyze billing trends, and collaborate with teams to enhance payment integrity while working onsite in Wisconsin. Key responsibilities Research and validate business decisions and system rationales to support edits and conduct testing to validate outcomes Analyze billing and coding patterns, identifying outliers with potentially high-risk practices Review and resolve appeals by analyzing medical documentation and collaborating with Clinical Services teams as needed Required qualifications Associate's degree in medical coding with 5+ years of medical coding experience, or high school equivalency with 8+ years of medical coding experience Completion of a medical coding program and certification in CPC, COC, RHIT, RHIA, CCA, and/or CCS Strong working knowledge of medical coding and regulatory guidelines, including CPT, HCPCS, ICD-10, OPPS, IPPS, and DRGs Experience with Epic healthcare software and/or Optum claims edit systems Knowledge of governmental medical payment policies/regulations and HIPAA regulations