Medical Coding Compliance Specialist
Theoria Medical
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $85,000 per year
Job Level
Mid-LevelSenior
About the role
- Conduct coding audits: Perform reviews of medical record documentation and coding to ensure accuracy, completeness, and adherence to regulatory requirements and coding guidelines (e.g., ICD-10-CM, CPT, HCPCS).
- Identify and mitigate risks: Analyze audit data to identify trends, potential compliance risks, and areas for improvement. Recommend and implement corrective action plans.
- Provide education and training: Develop and deliver educational programs, presentations, and one-on-one training sessions for physicians, and other staff on coding best practices and compliance issues.
- Stay up to date on regulations: Maintain expert knowledge of evolving federal and state regulations, CMS guidelines, and industry coding standards. Research and interpret new rules and policies.
- Respond to inquiries: Serve as a resource for internal and external questions related to coding, billing, and documentation compliance.
- Prepare reports: Document audit findings and present clear, concise reports to management, explaining risk areas and compliance issues.
- Investigate issues: Conduct investigations into potential non-compliant activities or billing discrepancies to determine root causes and recommend solutions.
- Collaborate across departments: Work closely with billing, revenue cycle management, and clinical departments to ensure seamless and compliant workflows.
Requirements
- Certification: Relevant, industry-recognized coding certification such as Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Professional Medical Auditor (CPMA) or equivalent.
- Education: An associate or bachelor’s degree in health information management or related field preferred but not required.
- Experience: A minimum of 5 years of experience in medical coding and auditing. Experience in professional services for Evaluation and Management coding, Chronic Care Management, and Risk Adjustment coding.
- Knowledge: Extensive knowledge of CPT, ICD-10-CM, and HCPCS coding systems, as well as Medicare and Medicaid regulations, is essential.
Benefits
- Work-Life Balance: Monday to Friday schedule for a fulfilling personal and professional life.
- Competitive Compensation: Be rewarded with a generous salary and benefits package.
- Career Growth Opportunities: Unlock your potential and advance in your career with our support.
- Supportive Work Environment: Join a team that values and appreciates your contributions.
- Comprehensive Training: Enhance your skills and knowledge through our extensive training programs.
- Compliance and Peace of Mind: Work with confidence knowing that we prioritize compliance with employment laws and regulations.
- Paid Time Off and Holidays: Enjoy well-deserved time off to relax and recharge.
- Life Insurance Coverage: Protect your loved ones with our employer-paid life insurance policy.
- Collaborative Team Environment: Thrive in a positive and collaborative work environment.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
medical codingcoding auditsICD-10-CMCPTHCPCScompliance analysisrisk mitigationreport preparationbilling discrepancies investigationeducation and training development
Soft skills
communicationcollaborationanalytical thinkingproblem-solvingpresentation skillsattention to detailorganizational skillsinterpersonal skillsadaptabilityleadership
Certifications
Certified Professional Coder (CPC)Certified Coding Specialist (CCS)Certified Professional Medical Auditor (CPMA)