Coding Compliance Specialist
This role is not as a traditional coder. This position is remote.
Daily responsibilities include:
- Ensures compliance with official coding guidelines, CMS regulations, payer requirements, and internal IH policies.
- Conducts comprehensive coding reviews/audits to identify errors, trends, and root causes impacting reimbursement, quality metrics, and compliance; includes internal/external audits, coding denials, CDI/Quality findings.
- Provides coder feedback and coaching based on audit findings; prepares and distributes audit results and coding performance reports.
- Creates and maintains educational materials, job aids, and coding guidance updates.
- Develops and delivers coding education (both in-person and virtual). Supports onboarding and ongoing competency development for new and experienced coders.
- Acts as a coding resource to other departments such as Case Management, CDI, and Insurance Authorization.
- Ensures data reliability and appropriate reimbursement by maintaining current expertise in ICD-10-CM/PCS, CPT, and HCPCS conventions and CMS directives; actively participates in education.
Minimum Qualifications:
- 5 years coding experience in an acute care facility
- Expert-level knowledge of medical terminology, anatomy and physiology, ICD-10-CM/PCS, CPT, and HCPCS coding conventions, and CMS coding requirements
- Proficient in word processing and PC based spreadsheet program including Excel and PowerPoint
- Ability to research coding questions and use educational resources
Licensure/Registration/Certification:
- AHIMA credentialed as one of the following: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), OR Certified Coding Specialist (CCS)
Desired Qualifications: