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)
Under the supervision of the Clinical Coding Manager, the Clinical Coding Specialist is responsible for assisting the center’s Clinical Coding Associates and completing all daily coding projects. The Clinical Coding Specialist is also responsible for working with the physicians on proper documentation and coding practices as it pertains to CMS guidelines.
ESSENTIAL DUTIES AND RESPONSIBILITIES
1. On a daily basis, abstracts and assigns diagnosis codes for each patient encounter by using the official ICD-10-CM Coding Guidelines.
2. Monitors the daily coding activities of the center teams and assists as necessary with workload and guidance as it pertains to the Official ICD-10-CM Coding Guidelines.
3. Works with all physicians on documentation and coding education.
4. Performs regular audits on physician documentation to ensure compliance with CMS guidelines.
5. Maintains a safe and clean working environment by complying with company procedures, rules and regulations
6. Maintains open channels of communication with other company departments.
7. Answers all inquiries in a professional and courteous manner.
Job Type: Full-time
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Work Location: In person
0 Coding Compliance Specialist jobs found in Miami, FL area