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)
Work Situation Factors
Position involves competing demands, performing multiple tasks, working to deadlines, occasional work beyond normal business hours, and responding to customer issues. Regular attendance is an essential function of this job to ensure continuity of services. Position is subject to drug testing in accordance with applicable State and Federal regulations and City of Las Cruces policies.
Work is performed primarily in an office setting, but occasionally performs on-site visits to agencies, firms, and construction areas where various hazards may exist involving exposure to all phases of construction, weather conditions, noise, debris, dust, and other related obstacles and hazards.
Physical Factors
Light physical demands, mostly desk work; ability to ambulate on uneven surfaces around construction sites. Frequent to constant use of a personal computer.
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