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)
The Billing and Coding Specialist is responsible for supporting the department in maximizing revenue and cash flow by validating ICD and CPT codes, performing charge entries, following up on all outstanding A/R, including resolution of denials, and generating effective written appeals to carriers to maximize reimbursement on incorrectly denied claims. The Billing and Coding Specialist handles all correspondence related to an insurance or patient account, contacting carriers, patients, and other facilities as needed to get maximum payment on accounts and identify issues or changes. They utilize training and knowledge to interpret, understand, and apply appropriate coding, apply complex Medicare guidelines to reduce claim denials, and consistently practice established Peak standards and expectations to achieve superior client satisfaction and retention.
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Gastro Care Partners is the national partner for successful regional gastroenterology practices. We believe in the mantra “medicine is local.” Gastro Care Partners provides high-performing regional practices with the resources necessary to thrive in today’s dynamic healthcare landscape while maintaining their practices’ identities.
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