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)
Bachelor’s degree.
Proficient with Windows-based operating environment, Word, Excel, e-mail and using the internet. Must be able to use computer to complete tasks as required.
Excellent mastery of language. Strong writing skills, ability to clearly communicate verbally and in writing. Strong organizational skills and interpersonal skills.
Initiative and proven ability to research and identify resources.
Demonstrates confidence and is knowledgeable about recruitment strategies.
Must have a current valid Ohio driver’s license and an insured personal vehicle for agency use. Must have a good driving record. Must have a history of satisfactory job performance. Must have a record of reliable work attendance.
Must be able to meet all requirements and obtain all certificates required to perform the job or any aspect of the job, and to access funding for performance of any aspect of the job.
Work experience in provider/personnel recruitment.
Professional experience with resource identification.
Work experience in the Developmental Disabilities system.
Complete compliance reviews of certified providers in accordance with the Ohio Department of Developmental Disabilities rules and regulations.
Identify providers/resources needed by county residents with developmental disabilities and their families; design and provide user-friendly communication about these providers/ resources.
Engage in/coordinate targeted provider recruitment activities, including provider fairs.
Assist with the development and maintenance of a searchable data base of providers that can meet support needs of county residents with developmental disabilities and their families.
Assist with overall coordination of caregiver trainings/information sessions.
Communicate in a positive, reassuring manner with service recipients and their families
Typically, Monday-Friday, 8:00a-4:00p. Flexible as needed.
6
280 calendar days (initial and non-initial)
This agency supports the full intent and goals of Equal Employment Opportunities and insures that all employees and applicants will be afforded equal opportunities for appointment, promotion, training, career advancement and recognition without regard to mental handicap, physical handicap, sex, race, color, religion, national origin, age or political affiliation.
R. December 2021
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