Coding Compliance Specialist researches and develops the pre-certification insurance policy standards and criteria used by case management and utilization reviewers that will ensure that requested medical services are appropriate and medically necessary. Collaborates with medical professionals to resolve questions about policy development and standards. Being a Coding Compliance Specialist assigns correct ICD, CPT, or other coding assignments for medical procedures that support policy standards in claims systems. Provides expertise and solutions to users regarding the appropriate coding for claims. Additionally, Coding Compliance Specialist has broad knowledge of medical coding systems. May require an associate degree in healthcare administration, a related field, or equivalent. Requires AAPC Certified Professional Coder (CPC). May alternatively require Certified Coding Specialist (CCS) certification. Typically reports to a manager. The Coding Compliance Specialist occasionally directed in several aspects of the work. Gaining exposure to some of the complex tasks within the job function. To be a Coding Compliance Specialist typically requires 2 -4 years of related experience. (Copyright 2024 Salary.com)
Company: KFMC Health Improvement Partners
Position: Coding Specialist
Job Classification: Exempt, Full-time
Work Schedule: Mutually Determined
Reports to: Director of Clinical Care Review and Quality Improvement
Location: Topeka, KS (on-site)
KFMC Health Improvement Partners (KFMC) is a not-for-profit organization focused on improving healthcare quality. We inspire meaningful change and sustained high performance within the organizations and communities where we work. We’re a diverse team of multi-disciplinary professionals all focused on the same vision…best health outcomes for everyone. We believe our team members do their best work when they love what they do, and we have created an environment that fosters creativity, excellence and fun! We prioritize and value the things that are important to us, both as people and as professionals, including flexibility and a family-friendly culture. KFMC is currently seeking a Clinical Coding Specialist. As a member of the Clinical Care Review Team, this position will support our Clinical Care Review services across multiple states, complete coding reviews and process selected cases and/or special requests in a timely and accurate manner and in accordance with the requirements for Independent Review Services. Graduate of an accredited college or university with completion of an RHIA, RHIT, CCA, CCS, CCS-P certification is required. A minimum of two (2) years of experience clinical coding, or in a clinical position in the health care field is required; experience in DRG coding is preferred.
Primary Accountability:
This position is responsible for completing reviews and processing of selected cases and/or special requests in a timely and accurate manner and in accordance to KFMC contract requirements. Abstracts clinical information from a variety of medical records, charts and documents and assigns appropriate ICD-10 and/or CPT-4 codes to patient records according to established procedures. Works with coding databases and confirms DRG assignments. Inputs and maintains data on procedures required for state or other reporting. This position works in collaboration with internal staff members and/or departments as well as external sources; the position is expected to function independently, as well as collaboratively.
Major Duties:
Qualifications:
Physical Demands:
Work Environment:
Additional Duties:
Additional duties and responsibilities may be added to this job description at any time. The job description does not state or imply that these are the only activities to be performed by the employee(s) holding this position. Employees are required to follow any other job-related instructions and to perform any other job-related responsibilities as requested by their supervisor.