Medical Coding & Prior Authorization Specialist

Crossing Rivers Health•Prairie du Chien, WI

About The Position

Medical Coding & Prior Authorization SpecialistFull Time / Days40 hours per week Come join our team! Crossing Rivers Health provides competitive pay along with an excellent benefits package including medical, dental, vision; life insurance, short term disability, paid time off, a retirement plan w/company match, and more! Our core values are practiced and exhibited throughout the organization in our actions and in services provided.Joy : Unity : Integrity : Compassion : Excellence The Medical Coding and Prior Authorization Specialist plays a dual role in supporting accurate clinical documentation and ensuring timely authorization of services for patients at Crossing Rivers Health. This position is responsible for coding all/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.

Requirements

High School Graduate or General Education Degree (GED) : Required
Associate’s Degree in Health Information Management, Medical Coding, or related field: Required
Registered Health Information Technician or related certification within 6 months of hire.
2+ years of medical coding experience in a Critical Access Hospital or similar setting preferred.
Proficient in Microsoft Office

Nice To Haves

Prior authorization and insurance verification experience preferred.
Epic experience preferred

Responsibilities

Reviews clinical documentation to ensure coding accuracy, completeness, and compliance with regulations.
Assigns diagnoses, procedural/treatment, professional billing codes for all patient type encounters (Clinic, Center for Specialty Care, Emergency, Urgent Care, Outpatient Services, Lab, Imaging, Physical/Occupational/Speech Therapy, Surgery, Observation/Inpatient, Obstetrics) utilizing ICD-10-CM, ICD-10-PCS or CPT guidelines
Working knowledge of modifier usage, CCI edits, HCPCS, LCD/NCI regulations
Data entry/verification/appropriate sequencing into electronic health record
Submit provider queries as appropriate following approved guidelines.
Identify and resolve clinical documentation and charge capture data discrepancies
Initiates and manages prior authorization requests for surgical procedures, specialty services, imaging, and rehabilitation therapies.
Verifies medical necessity and payer-specific criteria prior to submission of authorization requests.
Assists with denial follow-up and appeals related to coding or prior authorization
Collaborates with providers, nursing staff, and scheduling teams to obtain required clinical documentation for approvals.
Monitors pending authorizations, ensuring timely follow-up and communication with payers, providers, and patients.
Tracks and reports trends in authorization denials and coding discrepancies; participates in denial prevention initiatives.
Maintains current knowledge of payer guidelines, coding updates, and regulatory requirements.
Supports staff and providers through education on documentation and authorization best practices.
Contributes to a culture of accountability, continuous improvement, and patient-centered service.
Assist in provider education in use of coding guidelines and practices and proper documentation techniques
Assist with coding quality review activities for accuracy and compliance monitoring
Commitment to continuous learning as required to stay up-to-date on coding and prior authorization guidelines.
Other job duties and responsibilities as assigned to effectively meet the needs of the patients, the department, and the organization as a whole.