Coding Compliance Specialist

Coding Compliance Specialist I will perform code audits and abstraction using the Official Coding Guidelines for ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The Coding Compliance Specialist I will be involved with activities of auditing and code abstraction for the following programs; including but not limited to, Commercial Risk Adjustment, Medicare Advantage Risk Adjustment, and HHS and Medicare RADV (Risk Adjustment Data Validation). This is an in-office position.

• Review medical record information on both a retroactive and prospective basis to identify, assess, monitor and document claims and encounter coding information to include highest level of specificity as it pertains to Hierarchical Condition Categories (HCC)
• Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines
• Identifies revenue, reimbursement, and educational opportunities while remaining compliant with state and federal regulations.
• Complies with all aspects of coding, abides by all ethical standards, and adheres to official coding guidelines.
• Assist coding leadership by making recommendations for process improvements to further enhance coding quality goals and outcomes
• Provides measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding practices to ensure chronic conditions are recaptured annually
• Responsible for maintaining current knowledge of coding guidelines and relevant federal regulations through the use of current ICD-10-CM manual and other relevant material

POSITION SPECIFIC COMPETENCIES

• Risk Adjustment Coding (HCC) Experience

• High School Diploma
• AAPC/AHIMA certification
• Health care insurance and medical coding, billing and payment guidelines knowledge required
• Intermediate to advanced level of proficiency in Microsoft Excel, PowerPoint & Word.
• Experience is not required; will train the right candidate
• Extensive knowledge of ICD-9-CM, ICD-10-CM/PCS and CPT and HCPCS coding principles and billing guidelines.
• Experience in conducting medical record audits reviews required.
• Experience with CMS Risk Adjustment Data Validation Audits.
• Experience working effectively with common office software, coding software, EMR and abstracting systems
• Must have a basic understanding of medical terminology, disease process and anatomy and physiology.
• Proven ability to prioritized and organize multi-faceted/multiple responsibilities simultaneously in a fast paced, changing environment while meeting deadlines and turnaround time requirements.
• Certified Medical Coder (CCS, CPC, CPC-A, CCS-P, CRC) through AHIMA or AAPC (required)
• CRC (Certified Risk Adjustment Coder) certification, preferred.