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)
Who we are:
Spire Orthopedic Partners is a growing national partnership of orthopedic practices that provides the support, capital and operational resources physicians need to grow thriving practices for the future. As a Management Services Organization (MSO), Spire provides the infrastructure for administrative operations that allows practices to operate at their highest level, so doctors can focus their efforts on what matters most – patient care. Rooted in the 100-plus-year legacy of its founding partners, the network spans the Northeast with 128 physicians, over 1100 employees, and 28 locations from Connecticut, New York, and Massachusetts.
At Orthopedic Associates of Dutchess County, we believe our employees are our greatest asset. We believe in hiring the best people and cultivating a winning team. Investing in our employees’ future success is investing in our future success. We hire both experienced medical staff as well as those just starting out in the field looking for an opportunity to learn a profession. We promote from within whenever possible because we know our staff are highly trained and guided towards success!
What you’ll do:
The Certified Professional Coder will receive, review, and enter all charge documents, including office and hospital-based services. The Certified Professional Coder is responsible for the input of all charges related to the assigned physician or professional service, into the practice management system and is responsible for reviewing billing and procedure codes to ensure all billing guidelines are followed correctly. The Certified Professional Coder is classified as a nonexempt employee and is eligible to overtime pay with prior approval and in accordance with the practice’s personnel policies.
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Who you are:
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What we offer:
We are an equal-opportunity employer. Qualified Applicants are considered for positions and are evaluated without regard to actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex, or gender (including pregnancy, childbirth, and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances (referred to as “protected characteristics”).
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