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)
Description
JOB SUMMARY
Hospital Inpatient Coding :
The Hospital Coding Specialist III accurately codes inpatient conditions and procedures as documented in the International Classification of Diseases (ICD) Official Guidelines for Coding and Reporting and in the Uniform Hospital Discharge Data Set (UHDDS) and assignment of the appropriate MS-DRG (Medicare Severity-Diagnosis Related Group) or APR-DRG (All Patients Refined Diagnosis Related Groups) for complex, multi-specialty inpatient services.
This individual understands and applies applicable medical terminology, anatomy and physiology, surgical technology, pharmacology and disease processes.
The Hospital Coding Specialist III reviews professional and hospital inpatient medical record documentation and properly identifies and assigns :
JOB QUALIFICATIONS
EDUCATION
Minimum Required : Medical Coding Diploma or American Health Information Management Association (AHIMA) approved Health Information Management Degree or related program.
Preferred / Optional : None
EXPERIENCE
Preferred / Optional : Experience with electronic health record systems. Academic or level I or II trauma experience is a plus.
CERTIFICATIONS / LICENSES
Minimum Required : Active credential of Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA) through the American Health Information Management Association (AHIMA) required at the time of hire.
Preferred / Optional : None
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Last updated : 2024-04-24
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