Coding Compliance Specialist jobs in Hawaii
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)
Recently Added Coding Compliance Specialist jobs
Medical Coding Specialist (Modernization )
- Anthony & Associates, Inc.
-
Harbor, HI
FULL_TIME
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MEDICAL CODING MODERNIZATION SPECIALISTPearl Harbor, HI
Position Overview:
AAI is actively recruiting a Medical Coding Modernization Specialist.- This position will support coding operations and compliance as part of the Medical Modernization Program.
- The coding professional will conduct internal audits; monitor coding practices and documentation deficiencies to identify, develop, deliver training and monitor effectiveness of efforts to ensure improvement to documentation, coding completion, timeliness and accuracy rates for the MTF.
RESPONSIBILITIES:- Knowledge of The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-CM), procedural coding, healthcare common procedure coding system (HCPCS)/current procedural terminology (CPT) nomenclature, medical and procedural terminology, anatomy and physiology, pharmacology, and disease processes to perform the duties described. Knowledge of reimbursement systems, including Prospective Payment System (PPS) and Diagnostic Related Groupings (DRGs); Ambulatory Payment Classifications (APCs); and, ResourceBased Relative Value Scale (RBRVS).
- Knowledge of and the ability to interpret guidelines, rules and regulations developed by: Centers for Medicare & Medicaid Services (CMS), American Medical Association (AMA), American Heart Association (AHA) and other applicable Federal requirements so as to provide timely and accurate information relating to coding, billing and documentation.
- Excellent oral and written communication skills, interpersonal skills along with the confidence to present complex medical coding issues and educational instruction to a diverse audience. Must be comfortable in front of high ranking, professional staff and coding peers to training and respond to questions.
- Ability to write reports, business correspondence, and procedure manuals.
- Organizational, analytical, time management, statistical, and problem-solving skills.
- Advanced knowledge of computers, keyboard skills, and various software programs including Microsoft (word processing, spreadsheet and database) as well as coding software programs.
- Medical Coding Modernization Specialists will maintain the required continuing education hours and credentials as required by their national association certification at their own expense.
- Work Environment/Physical Requirements. The work is primarily sedentary. Requirements may include prolonged walking, standing, sitting, or bending. Carrying or lifting of medical records or documentation may be required daily. Use of one or more computer programs and monitors simultaneously is typical and frequent.
- Assists the MTF in identifying medical coding deficiencies by analyzing documentation and coding practices that may be misrepresenting or incorrectly capturing medical care activities.
- Analyzes historical encounter documentation and coding records from Government computer systems and medical records to identify clinical documentation improvement (CDI) and training opportunities.
- Compares documentation to code application to ensure accuracy. Tracks deficiencies for trending and corrective action.
- Collaborates with MTF leadership, MTF providers/staff, and other coding professionals related to the performance of tasks to address recurring documentation and coding deficiencies, Contacts providers to review findings to improve documentation practices as well as E&M leveling, capturing medical procedures and to improve diagnosis specificity issues IAW with coding guidelines.
- Develops focused training presentations from thorough analysis as outlined in the MTF modernization action plan. Seeks Government approval prior to delivering Government scheduled training to MTF providers and other staff.
- Creates and submits training activity reports to the MTF leadership. Presents reports to the Government weekly and identifies scheduling issues and obstacles to meeting improvement objectives.
- Creates monthly reports showing completed activities and improvement to metrics.
REQUIREMENTS:- Successful completion of academic requirements, at least at an associate's degree level from a health information management program is required.
- A Registered Health Information Technician (RHIT) or equivalent certification is required.
- Other coding certifications may be considered but will require Government acceptance in accordance with the Equivalency Determination Request process.
- Must have successfully completed requirements for International Classification of Diseases, Tenth Revision ICD-10-CM/PCS proficiency certification by AHIMA standards or the AAPC ICD-10-CM proficiency test prior to their start date if an equivalency determination request for AAPC certification(s) is authorized by the Government.
- Candidates will require a minimum of 10 years of medical coding experience in production coding environments within the past 10 years, in more than 4 medical and surgical specialties, involving assignment of ICD, E&M, CPT, and HCPCS codes. Coding, auditing and training for ancillary services such as physical, occupational therapy, speech, and nutritional medicine as well as home health, skilled nursing facilities, rehabilitation care and urgent care clinics are not qualifying.
- A minimum of four years of auditing, training, and/or compliance functions within the last eight years is required in at least 4 medical and surgical specialties as stated above OR Candidates with three years of auditing, compliance, or training experience involving professional coding within the last five years in a DoD coding environment may be considered in lieu of 10 years for those without DoD experience.
Auditing, compliance, or training experience is described as:- Auditing functions include development and execution of audit plan, conducting audit according to audit plan by reviewing required documentation and determining compliance with audit standards, communicating with stakeholders during all phases of audit, and reporting on audit findings.
- Training functions include identifying coding training opportunities; developing coding training plans, and development/delivery of coding training to coder and physician/provider audiences.
- Compliance functions include identifying compliance issues and analyzing practice patterns and recommending changes to policies and procedures; recommending/updating standard policies and procedures; contribute to risk assessments and mitigation strategies; and data collection and statistical report generation.
UNIQUE MILITARY HEALTH CARE DYDTEMD/PROCEDURED:- Armed Forces Health Longitudinal Technology Application (AHLTA).
- Composite Health Care System (CHCS) and/or MHS GENESIS.
- Defense Enrollment Eligibility Reporting System (DEERS).
- Essentris™ The client-server version of the Clinical Information System (CIS).
- Coding Compliance Editor (CCE).
- Biometric Data Quality Assurance Service (BDQAS)- https://bdqas.afms.mil/
- AFMS Internal Coding Audit Methodology – AFMOA Audit Tool/Coding Audit Review System (CARS), or current tool.
- MHS Coding Guidelines http://www.tricare.mil/ocfo/bea/ubu/coding_guidelines.cfm
- AFMS Centralized Coding Manual.
About AAIAAI is focused on delivering outstanding services to the federal government. We have extensive experience in the fields of cyber security, development, IT infrastructure, supply chain management and other professional services such as system design and continuous improvement. AAI is a VA CVE-certified Service-Disabled Veteran-Owned Small Business (SDVOSB), SBA certified Economically Disadvantaged Woman Owned Small Business (EDWOSB), and a Woman Owned Small Business (WOSB) with offices in Hampton Roads Virginia, Montgomery, AL, Washington DC and Atlanta.Fully qualified candidates are welcome to apply directly on our website at: https://aaionline.us/.Our benefits include:- Paid Federal Holidays
- Robust Healthcare and Dental Insurance Options
- 401a plan
- 401k plan
- Paid vacation and sick leave
- Continuing education assistance
- Short Term / Long Term Disability & Life Insurance.
Veterans are encouraged to applyAAI does not discriminate in employment opportunities, terms and conditions of employment, or practices on the basis of race, age, gender, religious or political beliefs, national origin or heritage, disability, sexual orientation, or any characteristic protected by law. Pending guidance from the Safer Federal Workforce, employees may in the future be required to provide evidence of COVID-19 vaccination or request and receive approval for a medical or religious exemption. - 10 Days Ago
Physician Coding Specialist
- The Queen's Health System
-
Honolulu, HI
FULL_TIME
- We are, and always will be, dedicated to improving the health of Native Hawaiians and all of the people of Hawai‘i. The Queen’s Health System began with a single hospital in 1859 founded by Queen Emma...
- 2 Months Ago
Compliance Specialist
- Employers Options
-
Kahului, HI
FULL_TIME
- JOB DURATION: 6-week assignmentSUMMARY: Provide administrative support and perform quality assurance and compliance reviews of all client intakes and applications for the Low-Income Energy Assistance ...
- 15 Days Ago
Compliance Specialist
- OFFICE OF HAWAIIAN AFFAIRS (OHA)
-
Honolulu, HI
FULL_TIME
- The Compliance Specialist participates in and provides technical review of mechanisms to accomplish the goals and objectives of the program. Activities include interaction with government agencies at ...
- 24 Days Ago
Athletics Compliance Specialist
- University of Hawaii
-
Hilo, HI
FULL_TIME
- Description Title: Athletics Compliance Specialist Position number: 81669 Hiring Unit: Athletics Location: UH at Hilo Date Posted: November 7, 2022 Closing Date: November 30, 2022 Band: B Salary: sala...
- 15 Days Ago
Safety & Compliance Specialist
- US11345-AIRGAS Airgas USA, LLC
-
Kapolei, HI
FULL_TIME
- R10036331 Safety & Compliance Specialist (Open) Location: Kapolei, HI - Filling industrial How will you CONTRIBUTE and GROW? Position: Safety and Compliance Specialist Location: Kapolei, HI Target Bas...
- 17 Days Ago
Coding Compliance Specialist jobs at Popular Companies
Customs Compliance Specialist
- Clean Harbors
-
Norwell, MA
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Compliance Specialist
- Network Funding, LP
-
Houston, TX
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EVV Compliance Specialist
- Addus Homecare
-
Frisco, TX
- >> We offer our team the best << Medical, Dental and Vision Benefits Continued Education PTO Plan Retirement Planning Li...
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Compliance Specialist
- Global Channel Management Inc.
-
Los Angeles, CA
- About the job Compliance Specialist Compliance Specialist needs 3+ years of strong experience workforce contract Complia...
- 4/17/2024 12:00:00 AM
Senior Quality & Compliance Specialist
- Bayer
-
Kihei, HI
- At Bayer we’re visionaries, driven to solve the world’s toughest challenges and striving for a world where 'Health for a...
- 4/17/2024 12:00:00 AM
Labor Compliance Specialist
- Global Channel Management Inc.
-
Los Angeles, CA
- About the job Labor Compliance Specialist Compliance Specialist needs 5 years working experiences related to Workforce c...
- 4/17/2024 12:00:00 AM
DHA Medical Coding Compliance Specialist-(Hybrid Remote)
- Serco North America
-
Oklahoma City, OK
- Position Description : Serco is excited to continue our support to the Defense Heath Agency (DHA) Medical Coding Program...
- 4/15/2024 12:00:00 AM
Product Expert - Compliance
- Haleon
-
Poznań, Greater Poland Voivodeship
- Hello. We’re Haleon. A new world-leading consumer health company. Shaped by all who join us. Together, we’re improving e...
- 4/9/2024 12:00:00 AM
About Hawaii
Hawaii (/həˈwaɪi/ (listen) hə-WY-ee; Hawaiian: Hawaiʻi [həˈvɐjʔi]) is the 50th and most recent state to have joined the United States, having received statehood on August 21, 1959. Hawaii is the only U.S. state located in Oceania, the only U.S. state located outside North America, and the only one composed entirely of islands. It is the northernmost island group in Polynesia, occupying most of an archipelago in the central Pacific Ocean.
The state encompasses nearly the entire volcanic Hawaiian archipelago, which comprises hundreds of islands spread over 1,500 miles (2,400 km). At the southea...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Coding Compliance Specialist jobs
$67,002 to $89,007
Most Popular Cities in Hawaii for Coding Compliance Specialist Jobs
What does a Coding Compliance Specialist do?
Coding Compliance Specialist in Altus, OK
With little or no supervision, plans, conducts and coordinates the daily operations of one of the Coding and Documentation Quality Assurance (CDQA) sub-teams.
December 14, 2019
Coding Compliance Specialist in Terre Haute, IN
Leads the initiatives and responsibilities of the Enterprise-Wide Coding implementation work groups applicable to their sub-team.
December 16, 2019
Coding Compliance Specialist in Portland, OR
This position audits medical records to ensure compliance with the organizations coding procedures and standards according to the CMS Coding Guidelines and Official ICD9 / ICD10 Coding Guidelines.
December 23, 2019