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)
Summary of Position: Responsible for the accurate and timely coding and abstracting of patient records using the ICD-10-CM and CPT classification systems. Ensures optimal reimbursement by applying all coding guidelines in the sequencing and assignment of codes. Interacts with providers to facilitate modifications to clinical documentation through the query process.
Primary Job Responsibilities:
Participates in the coding subcommittee groups actively contributing to the list of agenda items, resolution of issues and development of coding guidelines/quick reference guides.
Minimum Qualifications: Associates degree or progress towards a degree in Health Information Technology required however would consider candidate with Bachelor’s degree in related medical field plus medical terminology and anatomy and physiology. High school diploma or GED with a coding credential will be considered. Strong background in medical terminology, anatomy and physiology with working knowledge and skill in ICD-10-CM and CPT-coding principles preferred. Minimum of 3 years of coding experience in an acute care setting required.
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