Coding Compliance Specialist

About the role

The role of the Coding Compliance Specialist is to maintain organizational compliance with coding and medical record documentation. The person holding this position is responsible for reviewing the coding of professional services records for compliance with CMS, AMA and certified coding standards. This position will conduct internal chart audits, encounter form reviews, assists with teaching providers and staff coding and reporting results. This position will support any third party billing staff in areas related to coding or collections.

Responsibilities

• Ensure the medical claims are submitted accurately and in a timely manner by: Reviewing electronic health records to assign accurate ICD-10-CM and CPT/HCPCS codes based upon coding principles and official guidelines.
• Reviewing patient records documentation to ensure that services provided are accurate and meet guidelines.
• Monitoring billing performances to ensure optimal reimbursement while adhering to regulations prohibiting unbundling and other questionable practices; prepares periodic reports for clinical staff identifying unbilled charges due to inadequate documentation.
• Utilizing advanced knowledge of medical codes and coding procedures to assign and sequence appropriate diagnostic /procedure bulling coeds, in compliance with third party payer requirements.
• Interacting with patient care providers regarding billing and documentation policies, procedures and regulations; obtains clarification of conflicting or non-specific documentation.
• Monitoring external data sources to ensure receipt and analysis of all charges (EOBs).
• Reviewing and resolving the claim edit and charge review work queues.
• Affirming compliance with all regulatory agencies and payer sources: Regular compliance auditing and monitoring payers
• Creating reports of audit findings under the direction of the Billing Manager.
• Performing audits and analyses of payer denials; providing information on compliance issues arising from audits and formulates recommendations to providers regarding improving documentation practices.
• Affirms that providers and support staff have an understanding of their responsibility for accuracy of patient registration and coding of encounters.
• Lead or assist in developing education programs for providers around coding.
• Researching inquiries from providers and patients about fees, reimbursements and denials.
• Acting as a liaison between the Lead Providers, members of senior leadership and the billing department.
• Working with OCHIN to remedy billing problems.
• Interacting with department heads and administrative staff regarding implementation of new codes and revision of charge documents.
• Ensures the integrity of the HCPCS, CPT and ICD-10 codes are maintained in the electronic medical record (EMR).
• Maintains current coding credentials knowledge of State and Federal regulations applicable to coding by attending conferences, workshops and participating in OCHIN Billing Workgroups.
• Handle protected health information (PHI) in a manner consistent with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

  Requirements

  • High School Diploma or GED and certificate of successful completion of a coding exam is required.
  • Certification procedural coder (CPC, CPC-H, CCS, CCSP), accredited records technician (ART) or as a registered health information technician (RHIT).
  • Minimum of one year of experience working with Electronic Health Record and specialty coding.
  • At least two years' experience directly related to the duties and responsibilities specified in the job description.
  • Additional education and training is desirable with two year medical office experience and training.
  • Billing experience and chart auditing experience preferred.
  • Community health experience desirable.
  • Valid Oregon driver's license, reliable transportation, safe driving record and insurance coverage required.

    Qualifications

    • Knowledge of auditing concepts and principals.
    • Knowledge of patient care charts and patient histories.
    • Ability to analyze complex medical records and identify billable services.
    • Ability to maintain quality and safety standards.
    • Knowledge of current and developing issues and trend in medical coding procedure requirements.
    • Advance knowledge of medical coding procedures, systems, and regulatory issues within a specified area of medical specialty.
    • Knowledge of anatomy and physiology.
    • Analytical and problem solving skills.
    • Ability to gather data, compile information and prepare reports.
    • Knowledge of medical terminology.
    • Knowledge of ICD-9CM, ICD-10CM, and CPT-4 coding.
    • Ability to clear communicate medical information to professional practitioners and/or the general public.
    • Demonstrated ability to work effectively in a team environment.
    • High level of accuracy with numbers and data, which will become patient records.
    • Excellent interpersonal, oral, non-verbal and written communication skills.
    • Microsoft office suite including Microsoft Word, Excel, PowerPoint and database software.
    • Commitment and alignment to Virginia Garcia's mission, vision and values.
    • Bilingual/bicultural proficiency (Spanish/English spoken and written) desirable.

    Skills

    • Knowledge of auditing concepts and principals.
    • Knowledge of patient care charts and patient histories.
    • Ability to analyze complex medical records and identify billable services.
    • Ability to maintain quality and safety standards.
    • Knowledge of current and developing issues and trend in medical coding procedure requirements.
    • Advance knowledge of medical coding procedures, systems, and regulatory issues within a specified area of medical specialty.
    • Knowledge of anatomy and physiology.
    • Analytical and problem solving skills.
    • Ability to gather data, compile information and prepare reports.
    • Knowledge of medical terminology.
    • Knowledge of ICD-9CM, ICD-10CM, and CPT-4 coding.
    • Ability to clear communicate medical information to professional practitioners and/or the general public.
    • Demonstrated ability to work effectively in a team environment.
    • High level of accuracy with numbers and data, which will become patient records.
    • Excellent interpersonal, oral, non-verbal and written communication skills.
    • Microsoft office suite including Microsoft Word, Excel, PowerPoint and database software.
    • Commitment and alignment to Virginia Garcia's mission, vision and values.
    • Bilingual/bicultural proficiency (Spanish/English spoken and written) desirable.

    Benefits

    Virginia Garcia Memorial Health Center offers a comprehensive benefits package that includes:

    • Health insurance
    • Vision insurance
    • Dental insurance
    • Paid time off
    • Flexible spending accounts
    • Retirement savings plan
    • Employee assistance program
    • Discounts on health-related products and services
    • Professional development opportunities
    • Work-life balance initiatives

    Pay

    The salary range for this position is $[salary range], commensurate with experience.

    Schedule

    This position is full-time and works Monday through Friday, with occasional evening and weekend hours as needed.