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)
Job Summary
JOB REQUIREMENTS:
* High School Diploma or GED.
* CPC Coding Certification/CPC, CCS, CCSP
* 2 years medical coding experience
* Experience with process management
* PC experience and skills to include Microsoft Office
* Verbal and written communication skills
* Analytical skills
* Ability to travel 20% - 30% of the time in and out of state
PREFERRED JOB REQUIREMENTS:
* Associate or Bachelor’s degree
* CRC
* Experience in health insurance or health care setting
* Previous experience working on Risk Adjustment coding for either Medicare Advantage or Retail Exchange business
**This role is remote in Montana**
Salary Expectation: $54,600 depending on experience
We encourage people of all backgrounds and experiences to apply. Even if you don’t think you are a perfect fit, apply anyway - you might have qualifications we haven’t even thought of yet.
We encourage people of all backgrounds and experiences to apply.
Even if you don't think you are a perfect fit, apply anyway - you might have qualifications we haven't even thought of yet.
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
HCSC Employment Statement:HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.