Coding Compliance Specialist researches and develops the pre-certification insurance policy standards and criteria used by case management and utilization reviewers that will ensure that requested medical services are appropriate and medically necessary. Collaborates with medical professionals to resolve questions about policy development and standards. Being a Coding Compliance Specialist assigns correct ICD, CPT, or other coding assignments for medical procedures that support policy standards in claims systems. Provides expertise and solutions to users regarding the appropriate coding for claims. Additionally, Coding Compliance Specialist has broad knowledge of medical coding systems. May require an associate degree in healthcare administration, a related field, or equivalent. Requires AAPC Certified Professional Coder (CPC). May alternatively require Certified Coding Specialist (CCS) certification. Typically reports to a manager. The Coding Compliance Specialist occasionally directed in several aspects of the work. Gaining exposure to some of the complex tasks within the job function. To be a Coding Compliance Specialist typically requires 2 -4 years of related experience. (Copyright 2024 Salary.com)
At Riverside, everyday brings new and exciting challenges. You can expect an interesting environment where you’re part of making sure our organization is running optimally and safely, helping keep the community healthy. We provide the kind of paid training and opportunities that long-term careers are built on and we recognize hard workers who strive to make a difference. You will be able to succeed in our close-knit, safety-focused culture working together as a team. The careers we offer are meaningful because the work we do matters. Join us!
FTE: 1.000000
Shift: Days
Location: remote workforce position with hybrid option upon employee-management agreement
Summary:
The Professional Coding Compliance Specialist provides revenue cycle support to Riverside Medical Group and its coding team by regularly auditing provider documentation and corresponding coding to ensure correct, complete and compliant practices that fully support diagnoses reported and charges submitted for services rendered, meet regulatory and payor-specific requirements, and accurately describe the patient encounter; providing feedback and education to providers and coders based on audit results, regulatory changes, and industry trends; assisting with orientation of new providers, residents/fellows, and new members of the coding team.
This is a fully remote workforce position with hybrid option upon employee-management agreement
License or Certification Requirements:
Responsibilities:
Riverside Healthcare is revolutionizing care using leading-edge technology to diagnose and treat patients. We are ranked top in the nation for performance in neurosurgery, orthopedics, and heart surgery and have also been named one of the nation's 100 Top Hospitals by Truven Health Analytics seven times. Riverside is nationally recognized for our specialty programs in obstetrics, trauma, oncology, rehabilitation, geriatrics, occupational health, psychiatric services, and treatment of alcohol and chemical dependency, as well as patient safety. We combine innovation and convenience at state-of-the-art facilities located in communities throughout the greater Kankakee area.
Riverside Medical Center proves that truly progressive medicine is being delivered in Chicago's southwest suburbs and East Central Illinois. Join a team that is not only concerned with providing the best care possible but also with offering a work environment of advancement and growth. Riverside is a place that embraces a culture where opinions count and dedications is respected, where superior performance is rewarded with competitive salaries and excellent benefits.
Other information:
Exposure/Sensory Requirements
Exposure to:
Chemicals:
Video Display Terminals: Average
Blood and Body Fluids: Minimal risk
TB or Airborne Pathogens: Minimal Risk.
Sensory requirements (speech, vision, smell, hearing, touch):
Speech: Needed for presentations/training, telephone communication, facilitate meetings, communication with residents, families, visitors..
Vision: Needed to read memos and literature, computer entry.
Smell: Helpful to note presence of electrical/fire safety.
Hearing: Needed for telephone communication, meetings, alarms and listening to employee concerns, emergency procedures.
Touch: Needed to write, do computer entry, filing.
Activity/Lifting Requirements
Average Hours per Week: 40
Shift: Days
Percentage of time during the normal workday the employee is required to:
Sit: 60%
Twist: 5%
Stand: 10%
Crawl: 0%
Walk: 5%
Kneel: 5%
Lift: 10%
Drive: 15%
Squat: 5%
Climb: 0%
Bend: 5%
Reach above shoulders: 5%
The weight required to be lifted each normal workday according to the continuum described below:
Up to 10 lbs: Frequently
Up to 20 lbs: Occasionally
Up to 35 lbs: Not Required
Up to 50 lbs: Not Required
Up to 75 lbs: Not Required
Up to 100 lbs: Not Required
Over 100 lbs: Not Required
Describe and explain the lifting and carrying requirements. (Example: the distance material is carried; how high material is lifted, etc.):
Carry equipment to activity areas, Usually 50 or less feet, carried waist high. Examples carrying chairs, boxes, table - waist high, lift resident to a standing position.
Maximum consecutive time (minutes) during the normal workday for each activity:
Sit: 60-90
Twist: 5
Stand: 10
Crawl: 0
Walk: 10-30
Kneel: 5
Lift: 5
Drive: 0
Squat: 5
Climb: 0
Bend: 5
Reach above shoulders: 5
Repetitive use of hands (Frequency indicated):
Simple grasp up to 10 lbs. Normal weight daily
Pushing & pulling 20#
Fine Manipulation: Computer entry, phone dialing, writing, using calculator, filing.
Repetitive use of foot or feet in operating machine control: None
Environmental Factors (Time Spent) :
Inside hours: 8
Outside hours : 0
Temperature: Normal Range
Lighting: Average
Noise levels: Average
Humidity: Normal Range
Atmosphere:
Special Hazards :
Protective Clothing Required: None
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