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)
Xpress Wellness Urgent Care is seeking a qualified Certified Coding Specialist to join our team. The Coding Specialist is responsible for abstraction or accurate coding of procedures from the medical record to ensure optimal reimbursement while staying compliant with OIG, CMS, the local Medicare Administrative Contractor, all system policies and procedures and any state and other regulatory agencies. The Certified Coding Specialist must adhere to all CPT guidelines and ICD-10 Coding Guidelines.
Coding Specialist Responsibilities: