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)
Coding Specialist
GENERAL DESCRIPTION OF DUTIES AND RESPONSIBILITIES:
The Coding Specialist works as part of the billing team to abstract date from patient charts based on clinical documentation. The Coding Specialist reports to the Associate Director of Revenue Integrity.
SPECIFIC DUTIES AND RESPONSIBILITIES:
12. Must demonstrate good internal and external customer service skills.
OTHER FUNCTIONS
1. Employee will abide by the Code of conduct as documented in the Corporate Compliance Manual.
2. Must demonstrate a personal and professional commitment to Johnson Health Center and its mission.
3. Management may modify, add or remove any job functions as necessary, or as changing organizational needs require.
Actively demonstrates dedication and commitment to the core values of JHC:
1. Respect – We value and respect each patient, their family, ourselves and each other.
a. Every individual associated with Johnson Health Center will be treated with dignity and respect. We value and respect people’s differences, show empathy to our patients, their families and each other, and work collectively to build Johnson Health Center as a health center and an employer of choice.
2. Integrity – We are committed to doing the right thing every time.
a. Our actions reflect our commitment to honesty, openness, truthfulness, accuracy and ethical behavior. We are accountable for the decisions we make and the outcome of those decisions.
3. Excellence – We will pursue excellence each and every day in activities that foster, teamwork, quality improvement, patient care, innovation and efficiencies.
a. At Johnson Health Center, our medical, dental, pharmacy, behavioral health, front desk and administrative teams are passionately committed to the highest quality of care for our patients. We continually seek out ways to enhance the patient experience and promote an environment of continuous quality improvement.
4. Innovation – We value creativity, flexibility and continuous improvement efforts.
a. We are advocates and instruments of positive change, encouraging employees to engage in responsible risk-taking and working to make a difference. Out of the box thinking enables us to build on successes and learn from failures.
5. Teamwork – We understand that teamwork is the essence of our ability to succeed.
a. We work across functional boundaries, embracing diversity, for the good of the organization. Our collaborative approach ensures a culture of participation, learning and respect and serves to improve the quality of patient care. By focusing on a team based approach, the expertise of each Johnson Health Center employee is leveraged to optimize the patient experience.
REPORTING RELATIONSHIPS:
The Coding Analyst reports directly to the Associate Director of Revenue Integrity.
EVALUATION:
The Coding Specialist’s work performance will be evaluated annually by the Associate Director of Revenue Integrity.
QUALIFICATIONS:
1. High School diploma or equivalent. Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification required.
2. Two to five years’ previous coding experience required.
3. Must be self-motivated with well-developed organizational skills and computer experience, including, but not limited to, Word, Excel, and database functions.
4. Must possess strong communication skills; works well with external organizations and employees.
STATUS:
This position is a FLSA Non-Exempt position.
This is an OSHA low risk position.
This is an ADA negotiable position.
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