Coding Compliance Specialist jobs in Fresno, CA

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)

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Coding and Documentation Specialist
  • Central California Faculty Medical Group Inc
  • Fresno, CA FULL_TIME
  • Description

    Responsible for performing routine coding reviews of Evaluation & Management documentation, identify improvement opportunities, monitor accuracy and ensure documentation compliance. Works closely with departments to ensure documentation best practice, provide coding expertise and recommendations for risk mitigation strategies as needed.

    JOB FUNCTIONS:

    • Review select medical records to ensure compliance with 2023 Evaluation & Management documentation and coding guidelines
    • Provide limited documentation analysis for all New Providers
    • Provide standardized summary of findings and recommendations to Coding Educator
    • Applies CPT-4, ICD-10-CM, HCPCS and modifiers following coding standard guidelines.
    • Understands current regulatory coding requirements, which include Federal, State and local guidelines.
    • Keeps abreast of research projects within the department.


    Requirements

    Education:

    • High School Diploma or equivalent.

    Experience:

    • Three to five years of ICD-10-CM, CPT-4, HCPCS abstracting chart notes
    • Three to five years working in professional multi-specialty coding
    • Teaching Physician Rule proficiency preferred
    • Split/Shared Rule proficiency preferred

    Certification:

    • CPC certification equivalent; CPMA specialty certification required within one year of employment

    PERFORMANCE REQUIREMENTS:


    Knowledge, Skills and Abilities:

    • Strong understanding of current regulatory coding requirements, reimbursement and billing process of services rendered in a teaching facility, medical office, hospital or Skilled Nursing Facility.
    • Knowledge of medical specialties; medical diagnostic and therapeutic procedures; ancillary service
    • Knowledge of clinical compliance, best practices, medical record review, legal aspects of documentation
    • Knowledge and understanding of State and Federal regulations, healthcare billing practices and compliant claims preparation for Government and Commercial Payers
    • Ability to understand and interpret written material, including technical material, rules, regulations, instructions, reports, charts, graphs or tables
    • Proficient in various Microsoft applications such as Word, Excel and Outlook
    • Excellent written and verbal communication skills.
    • Excellent attention to detail.
    • Ability to identify problems and find creative and effective solutions.
    • Ability to research and follow up on issues.
    • Proficiency testing for baseline assessment.


    Equipment Operated:

    • Standard office equipment including computers, fax machines, copiers, printers, telephones, etc.


    Work Environment:

    • Position in a well lighted office environment. Frequent contact with a variety of people.


    Physical Requirements:

    • Involves sitting approximately 80 percent of the day, walking or standing the remainder. Some bending, stooping, and lifting up to 25 pounds.


    Safety:

    • All employees are responsible for complying with safe and healthful work practices as outlined in CCFMG’s Employee Safety and Injury and Illness Prevention Program and policies and procedures specific to their department needs.


  • 3 Days Ago

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Compliance Specialist
  • Stantec
  • FRESNO, CA FULL_TIME
  • Compliance Specialist - ( 240000RW ) Description We create great places and the connections that get people and goods moving—whether by car, bus, train, plane, or their own two feet. Working within th...
  • 1 Month Ago

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Compliance Specialist
  • Hinderliter de Llamas & Associates
  • Fresno, CA FULL_TIME
  • Company Overview The HdL Companies help cities, counties and special districts maximize revenues through research and discovery efforts, financial and economic analysis, and provision of software that...
  • 1 Month Ago

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Legal Compliance Specialist
  • CHEEMA TRANSPORT, INC
  • Kingsburg, CA FULL_TIME
  • Join Our Team as a Safety and Compliance Specialist! Are you passionate about ensuring safety and legal compliance in the trucking industry? We are seeking a dedicated Safety and Compliance Specialist...
  • Just Posted

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Compliance Specialist (Property Management)
  • GSF Properties Inc.
  • Fresno, CA FULL_TIME
  • DescriptionGSF Properties Inc. is looking for a Compliance Specialist in Fresno, CA, join a dynamic property management team!!We are looking for a highly organized, detail oriented, straight forward, ...
  • 26 Days Ago

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Compliance Specialist - Fresno
  • PG&E Corporation
  • Fresno, CA FULL_TIME
  • Requisition ID # 155298 Job Category: Administrative / Clerical Job Level: Individual ContributorBusiness Unit: Operations - OtherWork Type: OnsiteJob Location: Fresno Department Overview Major Infras...
  • 1 Month Ago

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0 Coding Compliance Specialist jobs found in Fresno, CA area

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Sr. Environmental Engineer/Scientist (EH&S)
  • Yorke Engineering
  • Fresno, CA
  • Job Description Job Description Join Yorke Engineering, LLC, an Environmental Consulting leader in California, while we ...
  • 3/28/2024 12:00:00 AM

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Internal Revenue Agent (Examiner) - 12 MONTH ROSTER
  • Department Of The Treasury
  • Fresno, CA
  • Duties WHAT IS THE SMALL BUSINESS/SELF-EMPLOYED (SB/SE) DIVISION? A description of the business units can be found at: h...
  • 3/28/2024 12:00:00 AM

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Internal Revenue Agent (Examiner) 12 MONTH ROSTER 'AMENDED'
  • Department Of The Treasury
  • Fresno, CA
  • Duties WHAT IS THE SMALL BUSINESS/SELF EMPLOYED (SBSE) DIVISION? A description of the business units can be found at: ht...
  • 3/27/2024 12:00:00 AM

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Internal Revenue Agent (Examiner-Joint Committee Specialist) 12 MONTH ROSTER 'AMENDED'
  • Department Of The Treasury
  • Fresno, CA
  • Duties WHAT IS THE LARGE BUSINESS & INTERNATIONAL (LB&I)DIVISION? A description of the business units can be found at: h...
  • 3/27/2024 12:00:00 AM

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Supervisory Internal Revenue Agent (12 month roster) AMENDED
  • Department Of The Treasury
  • Fresno, CA
  • Duties WHAT IS THE LBI - LARGE BUSINESS AND INTERNATIONAL DIVISION? A description of the business units can be found at:...
  • 3/27/2024 12:00:00 AM

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Inventory Specialist
  • WALGREENS
  • Fresno, CA
  • Responsible for executing, monitoring, and training inventory best practices and standard operating procedures for the e...
  • 3/27/2024 12:00:00 AM

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US, AVP, Commercial Banking
  • BMO Financial Group
  • Fresno, CA
  • For nearly 80 years, BMO Commercial Bank has served the needs of the entire food continuum. We understand how each eleme...
  • 3/26/2024 12:00:00 AM

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Internal Revenue Agent (Examiner) 12 MONTH ROSTER (AMENDED)
  • Department Of The Treasury
  • Fresno, CA
  • Duties WHAT IS THE LARGE BUSINESS & INTERNATIONAL (LB&I) DIVISION? A description of the business units can be found at: ...
  • 3/24/2024 12:00:00 AM

Fresno (/ˈfrɛznoʊ/ FREZ-noh; Spanish for "ash tree") is a city in California, United States, and the county seat of Fresno County. It covers about 112 square miles (290 km2) in the center of the San Joaquin Valley, the southern portion of California's Central Valley. Named for the abundant ash trees lining the San Joaquin River, Fresno was founded in 1872 as a railway station of the Central Pacific Railroad before it was incorporated in 1885. The city has since become an economic hub of Fresno County and the San Joaquin Valley, with much of the surrounding areas in the Metropolitan Fresno regi...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Coding Compliance Specialist jobs
$64,197 to $85,283
Fresno, California area prices
were up 2.7% from a year ago

Coding Compliance Specialist in Somerset, NJ
Make compliance and process related recommendations on medical coding issues.
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Coding Compliance Specialist in Jacksonville, FL
·        Perform specialized audits of patient medical records to ensure compliance with organization’s coding procedures and standards and provide feedback to analyst/educator and management.
February 04, 2020
Coding Compliance Specialist in Lebanon, PA
Provide monitoring and auditing functions as determined by the Regional Director of HIM Services, the HIM Coding Compliance Committee, TH Of NE Compliance Audit Plan, and as otherwise directed.
January 19, 2020