Prairie du Chien, Wisconsin, United States · On-site
Mid level
Description Medical Coding & Prior Authorization SpecialistFull Time / Days / On-Site40 hours per week Come join our team! Crossing Rivers Health provides competitive pay along with an excellent benefits package includin…
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Full-time
high school, associate degree, professional certificate
Medical, Dental, Vision, Life Insurance, Short Term Disability, Paid Time Off
Posted 25d ago
~40 hrs/week
Responsibilities
The Medical Coding and Prior Authorization Specialist is responsible for coding encounters and managing prior authorization processes to ensure compliance and maximize reimbursement. This role also involves reviewing clinical documentation and collaborating with healthcare providers to facilitate timely access to necessary care.
Requirements
Candidates must have a high school diploma and an associate degree in a related field, along with 2+ years of medical coding experience. Certification as a Registered Health Information Technician is required within 6 months of hire.
Full job description
Description
Medical Coding & Prior Authorization SpecialistFull Time / Days / On-Site40 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.
Essential Job Functions
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.
Competencies
Accountability – Ability to accept responsibility and account for his/her actions.
Accuracy – Ability to perform work accurately and thoroughly.
Business Acumen – Ability to grasp and understand business concepts and issues.
Communication – The ability to get one’s ideas across to others through oral or written means and to understand the ideas of others through effective listening skills.
Detail Oriented – Ability to pay attention to the minute details of a project or task.
Ethical – Ability to demonstrate conduct conforming to a set of values and accepted standards.
Honesty/ Integrity – Ability to be truthful and be seen as credible in the workplace.
Organized – Possessing the trait of being organized or following a systematic method of performing a task.
Reliability – The trait of being dependable and trustworthy.
Responsible – Ability to be held accountable or answerable for one’s conduct.
Reasonable Accommodations Statement
To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.
Requirements
Education
High School Graduate or General Education Degree (GED) : Required
Associate’s Degree in Health Information Management, Medical Coding, OR related/Medical Coding diploma/educational program: Required
Registered Health Information Technician or related Medical Coding certification within 6 months of hire.
Experience
2+ years of medical coding experience in a Critical Access Hospital or similar setting preferred.
Prior authorization and insurance verification experience preferred.
Computer Skills
Proficient in Microsoft Office
Epic experience preferred
Related keywords
Medical CodingPrior AuthorizationClinical DocumentationICD-10-CMICD-10-PCSCPTData EntryElectronic Health RecordDenial ManagementPayer GuidelinesCoding ComplianceHealthcareDocumentation Best PracticesAuthorization RequestsMedical NecessityCharge Capture
Crossing Rivers Health serves the healthcare needs of the people of Northeast Iowa and Southwest Wisconsin.
Industry
Hospitals and Health Care
Company size
201-500 employees
Founded
1957
Headquarters
PRAIRIE DU CHIEN, Wisconsin
LinkedIn followers
483
Crossing Rivers Health provides exceptional health care by extraordinary people whose highest priority is your lifetime of wellness.
Crossing Rivers Health will achieve the best outcome for every patient every time. It is where:
Patient expectations are exceeded
Physicians want to practice
Caring people want to work
The community sees a source of pride
The region associates our name with high-quality
We truly believe in and practice our values: Excellence; Integrity; Compassion; Unity; and Joy.
Crossing Rivers Health is a comprehensive community health center which provides more than 100 services to the people who live throughout Southwest Wisconsin and Northeast Iowa. We pride ourselves on our patient-driven approach to high-quality medical care, emergency medical care, hospice care, community health and wellness education, primary care and specialty clinics, and much more.
Offices: 37868 US Hwy 18, PRAIRIE DU CHIEN, Wisconsin 53821, US · 1800 Bronson Blvd, Fennimore, Wisconsin 53809, US · 37822 US Highway 18, Prairie du Chien, Wisconsin 53821, US · 424 N Beaumont Rd, Prairie du Chien, Wisconsin 53821, US · 426 N Beaumont Rd, Prairie du Chien, Wisconsin 53821, US
Medical CenterClinicBehavioral HealthHME Retail StoreBirthing CenterEmergency/urgent careRehabilitation and therapySurgeryOrthopedicsAllergy & Asthma
Based on 978 listings with disclosed salaries, most healthcare jobs in Wisconsin pay between $65k–$157k per year. Individual offers vary with seniority, company size, and specialization.
How many Healthcare jobs are open in Wisconsin right now?
There are currently 11,710 open healthcare positions in Wisconsin listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Healthcare roles in Wisconsin?
Companies currently hiring include American Addiction Centers, Ascension, Froedtert Health, ThedaCare, University of Wisconsin Hospital and Clinics, among others. Browse the listings above to see every active employer.
Are there remote or hybrid Healthcare jobs in Wisconsin?
Yes — 946 of the 11710 open healthcare positions offer remote or hybrid work (286 remote, 660 hybrid).
How do I apply for Healthcare jobs in Wisconsin?
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.