Coding and Compliance Specialist
Coding and Compliance Specialist
Posted on :
02-06-2025
Employer Active
1 Vacancy
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Job Description
SUMMARY: The Coding and Compliance Specialist is primarily responsible for coding and auditing related functions ensuring coding compliance data integrity and correct claims.
ESSENTIAL DUTIES AND RESPONSIBILITIES: The essential duties and responsibilities of this job include the following. These are the duties that define this job and are required to be performed by the incumbent. Other essential duties may be assigned.
QUALIFICATIONS:In order to qualify for this job the incumbent must possess the following qualifications or be able to secure them within 90 days.
ColumbusOncology Associates is an Equal Opportunity Employer and proudly a Drug-Free Workplace.All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity or national origin.
ESSENTIAL DUTIES AND RESPONSIBILITIES: The essential duties and responsibilities of this job include the following. These are the duties that define this job and are required to be performed by the incumbent. Other essential duties may be assigned.
- Perform daily review of coding and clinical documentation for pending charges allowing for correct data entry and clean claims
- Confirm appropriate clinical documentation is present in patient medical record
- Verify appropriate CPT and HCPCS codes are assigned for services provided
- Add or modify codes as necessary
- Apply payer-specific data requirements
- Assign appropriate modifiers to correctly reflect the service(s) provided
- Indicate NDC code as needed to accurately support medications administered
- Track and monitor outstanding documentation and/or missing charge tickets
- Follow-up with clinical manager and physicians as needed
- Maintain a current and detailed knowledge of regulatory and compliance related requirements impacting physician practices
- Stay up to date with current events related to professional billing and coding utilizing available resources; especially related to oncology
- Review payer newsletters and policies
- Collaborate and communicate with Lead Coding and Compliance Specialist management and physicians as necessary
- Assist Lead Coding and Compliance Specialist with education across the organization as needed to ensure compliance is understood achieved and maintained
- Achieve and maintain an understanding of government and payer initiatives impacting reimbursement (i.e. MACRA MIPS)
- Collaborate with Lead Coding and Compliance Specialist Lead Billing Specialist and billing team to review research and resolve clinical and coding related claim denials
- Assist with appeals process as necessary to ensure payment Coding and Compliance Specialist
- Communicate with physicians and/or clinical manager to obtain additional clinical knowledge
- Develop and maintain a working knowledge of practice management system and electronic health record
QUALIFICATIONS:In order to qualify for this job the incumbent must possess the following qualifications or be able to secure them within 90 days.
- EDUCATION AND/OR EXPERIENCE
- This job requires this education and/or experience background. Other desirable or preferred education and/or experience may be listed.
- 1-3 years of current experience in a physician practice business office performing medical coding with documentation review
- Understanding of professional coding and compliance and the associated variables that can impact claims and reimbursement
- Working knowledge of electronic claim edits and claim submission
- Strong knowledge of CPT and ICD-10 coding
- Strong medical terminology
- Moderate level of computer skills including EMR (electronic medical record) Microsoft Office applications (Outlook Word Excel) and use of the internet
- High school diploma or GED
- Oncology experience preferred
- This job requires this education and/or experience background. Other desirable or preferred education and/or experience may be listed.
ColumbusOncology Associates is an Equal Opportunity Employer and proudly a Drug-Free Workplace.All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity or national origin.
Required Experience:
Manager
Employment Type
Full-Time
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