Medical Coding Compliance Specialist

Relevant coding certification (CPC, CCS, CPMA, or equivalent). Associate or bachelor’s degree in health information management or related field preferred. Minimum of 5 years of experience in medical coding and auditing. Experience with professional services for Evaluation and Management coding, Chronic Care Management, and Risk Adjustment coding. Strong knowledge of CPT, ICD-10-CM, HCPCS coding systems. Strong knowledge of Medicare/Medicaid regulations. Analytical skills for root cause analysis and trend evaluation. Excellent verbal, written, and presentation skills. Proactive problem-solving skills. High degree of integrity and ability to maintain confidentiality.

Conduct audits of medical records and coding practices for compliance. Identify compliance risks and recommend corrective actions. Develop and deliver training on coding best practices and regulations. Maintain knowledge of coding standards and regulations. Serve as a resource for coding and documentation inquiries. Prepare reports on audit findings and compliance issues. Investigate non-compliant activities and recommend solutions. Collaborate with billing, clinical, and revenue cycle teams.