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)
At Bristol Health, we begin each day caring today for your tomorrow. We have been an integral part of our community for the past 100 years. We are dedicated to providing the best possible care and service to our patients, residents and families. We are committed to provide compassionate, quality care at all times and to uphold our values of Communication, Accountability, Respect and Empathy (C.A.R.E.). We are Magnet ® and received the 2020 Press Ganey Leading Innovator award for our rapid adoption and implementation of healthcare solutions during the COVID-19 pandemic. Use your expertise, compassion, and kindness to transform the patient experience. Make a difference. Make Bristol Health your choice. Perform ongoing chart audits of new and established provider medical records and billing documentation along timelines established by Billing Manager.
Educational / Minimum Requirements:
AS degree with three years health experience. BS Degree preferred.
Must successfully complete a coding certificate program.
Must be a Certified Professional Coder (CPC)
Additional auditing experience strongly preferred.
State/Federal Mandated Licensure or Certification Requirements:
Certified and experienced medical coding background is required.
CPC Required.
CPMA preferred.
Bristol Hospital Mandated Educational Requirements:
General orientation at time of hire. Fire/Safety/Infection Control annually. Other programs as mandated by Hospital.
Special Requirements:
None
Physical Requirements:
Must be able to sit, stand, stoop, bend for extended periods of time.
Work Environment:
Normal office conditions. Requires continued use of computer screen and data input requiring fine dexterity and movements. Vision and hearing corrected to normal.
Cognitive Requirements:
Ability to comprehend and execute written and/or oral directions. Ability to work independently. Ability to make judgmental decisions. Ability to follow through and complete tasks with minimal direction.
Disclaimer
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.