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)
Center for Learning and Innovation
Full Time | Hourly
We’re committed to compassionate care for all. Our patients. Our employees. You.
At La Clinica, we love our patients and enthusiastically treat them with the same care, respect, and dignity that we would our friends, family, and neighbors because that's who they are. If this appeals to you, La Clinica might be the right place to build your career. We’re looking for the right team members to treat our patients with this level of care.
We extend our commitment to compassionate care to our employees as well. We invest in our employees' lives through competitive pay, comprehensive benefits packages, easy access to wellness, personal and professional development workshops, and a focus on healthy work-life harmony. Check out our careers page to learn more about why our employees love working at La Clinica.
The Coding Compliance Specialist’s primary job function is to maintain organizational compliance with coding and medical record documentation. The Coding Compliance Specialist is responsible to review the coding of professional service records for compliance with CMS, AMA and certified coding standards. This position will conduct internal chart audits, encounter form reviews, assists with teaching providers/staff coding, and reporting results. This position will support any third-party billing staff in areas related to coding and/or collections. Utilizes advanced knowledge of specialty coding to analyze patient medical records, ensuring that documentation by providers conforms to legal and procedural requirements.
Accountabilities Include:
Performs Essential Job Duties
Equity Statement
At La Clinica, we commit to engage everyone in a welcoming, respectful, and loving way and to maintain the dignity and value of all people above everything else. These standards align with our organization’s vision of absolute excellence, open-hearted community, and well-being for all.
Customer Service:
Develops and maintains professional, support-oriented working relationships with patients, employees, team members, and community partners. Demonstrates continuous improvement in achieving “developing” and “fully competent” levels of La Clinica’s Behavioral Standards.
Follow La Clinica’s SERVE standards and they are the following:
Qualifications:
Must be able to interact with a variety of individuals at various levels under stressful circumstances while exercising sound judgement, tact, and diplomacy; work productively both independently and in a team setting; communicate with clarity, both verbally and in writing to groups and individuals.
Education and/or Experience:
Required:
Preferred:
Language Skills:
Equity Statement:
At La Clinica, we commit to engage everyone in a welcoming, respectful, and loving way and to maintain the dignity and value of all people above everything else. These standards align with our organization’s vision of absolute excellence, open-hearted community, and well-being for all.
For more information, please visit our website at: https://laclinicahealth.org/patients/approach/
Applications will be reviewed by the appropriate Department for interview; those selected must be able to provide proof of legal right to work in this country. La Clinica is a drug free work environment. Equal Opportunity Employer. La Clinica complies with the Americans with Disabilities Act. If you consider yourself disabled and desire assistance in the application process, please contact the Human Resources Department.