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)
Description
We are seeking a highly skilled and experienced Compliance Director to join our team. The Compliance Director establishes and implements an effective compliance program to prevent illegal, unethical, or improper conduct. The Compliance Director evaluates risk and advises the CEO and Governing Board by monitoring and reporting results of the compliance, risk and ethics efforts of the company. The Compliance Director, together with the CEO, is authorized to implement all necessary actions to ensure achievement of the objectives of an effective compliance and risk program.
Requirements
A Bachelor’s Degree or a degree in compliance and risk management preferred.
A current certification in Healthcare Risk Management, or ability to obtain within two (2) years of hire.
Three (3) or more years of management experience in healthcare to ensure the ability to understand the operational, financial and regulatory requirements.
Demonstrated compliance competencies, including the functional areas of CMS regulations, healthcare reform, accreditation standards, hospital and medical staff by-laws and other.
Excellent communication skills to include oral and written comprehension/expression.
Presentation and meeting facilitation skills.
Ability to work in a stressful environment, manage a heavy workload, balance changing priorities and deadlines, to balance NCMC needs and to facilitate conflict resolution.
Ability and willingness to exhibit behaviors consistent with principles of NCMC.
Ability and willingness to work long hours as needed to meet job requirements.
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