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)
Summary
Requisition #:
Entity/Department: Goshen Hospital / Health Information Management
Shift/Hours: Days /Full Time, 80 Hours Per Pay Period
Training for this position is onsite for 2-3 months.
Code medical records using ICD-9-CM and CPT-4 Classification Systems and ICD-10-CM and ICD-10-PCS. Abstract medical records using Meditech Chart Coding/3M Software Systems. Group medical records into DRG or ASC groups. Optimizes reimbursement with attention to various payer guidelines. Functions as a resource regarding appropriateness of codes, interpretation of documentation, medical terminology, and reimbursement. Participates in quantitative review of documentation using given criteria.
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