Coding Compliance Specialist

About the role

The Coding Compliance Specialist at La Clinica Center for Learning and Innovation is responsible for maintaining organizational compliance with coding and medical record documentation. This includes reviewing and assigning accurate ICD-10-CM and CPT/HCPCS codes, conducting internal chart audits, assisting with teaching providers/staff coding, and supporting third-party billing staff.

Responsibilities

• Ensure medical claims are submitted accurately and in a timely manner.
• Review electronic health record to assign accurate ICD-10-CM and CPT/HCPCS codes based on coding principles and official guidelines.
• Reviews patient records documentation to ensure that services provided are accurate and meet appropriate guidelines.
• Maintain compliance with all regulatory agencies and payor sources.
• Conducts quarterly compliance auditing and monitoring for all payors.
• Communicates with providers and clinical coordinators/team leads regarding new regulatory guidelines for billing and documentation compliance.
• Acts as a liaison between physicians and clinical staff to resolve issues involving coding and documentation requirements and procedures.
• Responds to inquiries regarding CPT, HCPCS and ICD-10 coding.
• Acts as a liaison between the medical coordinators, members of senior leadership, and the coding department.
• Works with OCHIN billing service to remedy coding issues.
• Interacts with department heads and other administrative staff regarding implementation of new codes and revision of charge documents.
• Maintains fee schedules and provider master file.
• Participates in OCHIN Billing Workgroup.

Requirements

• Must be able to interact with a variety of individuals at various levels under stressful circumstances while exercising sound judgement, tact, and diplomacy; work productively both independently and in a team setting; communicate with clarity, both verbally and in writing to groups and individuals.
• Minimum: High School Diploma or GED equivalent. Certification in ICD-10, CPT and HCPCS coding is required. Minimum one year experience working with Electronic Health Record and specialty coding with one to three years’ experience directly related to the duties and responsibilities field.
• Excellent interpersonal communication and problem-solving skills. Skills to intervene and promote reconciliation, compromise and positive outcomes in difficult interactions.
• Skilled at using electronic health records as applicable to area of work (EPIC, Wisdom).

Qualifications

• Must be able to interact with a variety of individuals at various levels under stressful circumstances while exercising sound judgement, tact, and diplomacy; work productively both independently and in a team setting; communicate with clarity, both verbally and in writing to groups and individuals.
• Minimum: High School Diploma or GED equivalent. Certification in ICD-10, CPT and HCPCS coding is required. Minimum one year experience working with Electronic Health Record and specialty coding with one to three years’ experience directly related to the duties and responsibilities field.
• Excellent interpersonal communication and problem-solving skills. Skills to intervene and promote reconciliation, compromise and positive outcomes in difficult interactions.
• Skilled at using electronic health records as applicable to area of work (EPIC, Wisdom).