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)
Position Summary
The role of the Coding Specialist – Certified reports to the Coding Manager. This position is responsible for the application of the appropriate diagnostic and procedural codes to individual patient medical records for data retrieval, analysis and claims processing.
Essential Position Responsibilities
Qualifications
Work Environment: This position will spend 80% of time sitting while performing work in a standard office environment. This position will spend 20% of time standing and/or walking while pushing, pulling, lifting, and/or carrying up to 50 lbs.
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