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)
This position is responsible for the timely auditing and coding of professional services based on provider documentation, ensuring that all services are in compliance with the Tulane University Medical Group (TUMG) Guidelines. Responsibilities also include maintaining knowledge base relative to billing functions, internal and external regulations and documentation issues. This individual is required to maintain current knowledge of CMS and Louisiana guidelines that govern reimbursement for professional services. This person must be able to work independently and process large quantities of data. The ability to communicate clearly and professionally with providers, department administrators, and the TUMG staff and respond timely and accurately to inquiries are key elements required of the individual in this position.
Required Knowledge, Skills, and AbilitiesProficient computer skills and a working knowledge of Microsoft Office software applications, including Word and Excel
Excellent written and verbal communication skills
Ability to prepare and present educational material to physicians
Ability to work independently and demonstrate initiative
Good organizational skills
Ability to be flexible and proactive in a changing environment
Tactful and professional interpersonal relationships with others
High School Diploma or equivalent
5 years' multi-specialty physician services coding or auditing experience
High School Diploma or equivalent plus certification as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) or Certified in Healthcare Compliance (CHC)
Accurate keyboarding skills
Working knowledge of revenue cycle
One year IDX Meditech and EMR experience such as EPIC and eClinical works (eCw)