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Medical Coding Compliance Specialist
Theoria MedicalMedical Coding Compliance Specialist ensuring coding accuracy and compliance at Theoria Medical. Collaborating with clinical and billing teams to support quality patient care.
About the role
Key responsibilities & impact- Conduct Coding Audits
- Perform detailed reviews of medical record documentation and coding to ensure accuracy, completeness, and compliance with ICD-10-CM, CPT, HCPCS, and payer guidelines.
- Identify and Mitigate Risks
- Analyze audit findings to identify compliance trends, risks, and opportunities for improvement.
- Recommend and support corrective action plans.
- Provide Education and Training
- Develop and deliver educational sessions and one-on-one guidance for physicians and staff regarding coding best practices and compliance standards.
- Stay Up to Date on Regulations
- Maintain current knowledge of CMS guidelines, federal and state regulations, and industry coding standards.
- Research and interpret new coding and billing policies.
- Respond to Inquiries
- Serve as a resource for coding, billing, and documentation compliance questions across departments.
- Prepare Reports
- Document audit findings and prepare clear, concise reports for leadership outlining risks and recommendations.
- Investigate Compliance Issues
- Conduct investigations into potential non-compliant activities or billing discrepancies and assist in identifying root causes and solutions.
- Collaborate Across Departments
- Partner closely with billing, revenue cycle management, providers, and operational teams to support compliant and efficient workflows.
Requirements
What you’ll need- Minimum of 5 years of experience in medical coding and auditing.
- One or more of the following certifications is required:
- Certified Professional Coder (CPC)
- Certified Coding Specialist (CCS)
- Certified Professional Medical Auditor (CPMA)
- Equivalent industry-recognized certification
- Associate’s or Bachelor’s degree in Health Information Management or a related field preferred, but not required.
- Experience with Evaluation and Management (E/M) coding, Chronic Care Management (CCM), and Risk Adjustment coding preferred.
- Extensive knowledge of CPT, ICD-10-CM, and HCPCS coding systems.
- Strong understanding of Medicare and Medicaid regulations and compliance standards.
- Strong analytical and problem-solving abilities
- Excellent written, verbal, and presentation communication skills
- High attention to detail and organizational skills
- Ability to maintain confidentiality and professionalism with sensitive patient information
Benefits
Comp & perks- Paid Time Off
- 401(k) with employer matching and participation
- Medical, vision, and dental insurance for eligible candidates
- Short and long-term disability insurance for eligible candidates
- Employer-paid life insurance policy
- Technology and tools designed to streamline workflows and improve efficiency
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
medical codingcoding auditsICD-10-CMCPTHCPCSEvaluation and Management codingChronic Care Management codingRisk Adjustment codingcompliance analysisreport preparation
Soft Skills
analytical skillsproblem-solvingcommunication skillsattention to detailorganizational skillsprofessionalismconfidentialityeducational trainingcollaborationrisk mitigation
Certifications
Certified Professional Coder (CPC)Certified Coding Specialist (CCS)Certified Professional Medical Auditor (CPMA)Health Information Management degree