Coding Compliance Specialist - HM

Core Clinical Partners stands at the forefront of Emergency and Hospital Medicine, delivering unparalleled services through a model that emphasizes patient-centric care and operational excellence. Our corporate values – Genuine, Accountable, Dynamic, Respectful, and Fun – are the pillars that uphold our commitment to revolutionize healthcare delivery.

The Coding Compliance Specialist is responsible for extracting clinical information from a variety of electronic medical record systems to analyze medical documentation and ensure proper assignment of CPT billing selection by utilizing coding guidelines established by the Centers for Medicare and Medicaid Services (CMS). The Coding Compliance Specialist has a deep understanding of medical terminology, coding guidelines, and healthcare regulations.

• Essential Duties:

• Review and analyze medical records and documentation for inconsistent documentation practices and offer remediating solutions.
• Perform outreach/education for new and existing coders on Emergency Medicine & Hospital Medicine coding and documentation requirements using a variety of formats.
• Assign appropriate ICD-10, CPT, and HCPCS codes to diagnoses, procedures, and services based on medical documentation.
• Validate the accuracy of codes and ensure adherence to coding guidelines and regulations.
• Maintain up-to-date knowledge of coding standards, regulations, and payer policies.
• Ensure quality and productivity goals set by Coding Manager is met.
• Ensure compliance with federal, state, and payer-specific coding guidelines and requirements.
• Review and address coding discrepancies and provide feedback coding leadership team.
• Conduct audits of coded records to ensure accuracy and compliance.
• Provide recommendations for coding improvements and best practices.
• Review new business medical records for documentation opportunities and templating education.
• Utilize coding software and electronic health record (EHR) systems efficiently.
• Stay informed about updates and changes to coding systems and software.
• Serves as a resource for expert knowledge in coding and documentation requirements.
• Perform other related duties as assigned.

• Skills, Knowledge, Abilities:

• Strong organizational skills with the ability to multi-task in a fast-paced environment.
• Ability to adapt, modify and prioritize while adhering to strict deadlines and a willingness to shift priorities to meet the needs of the organization.
• Knowledge and understanding of medical coding and billing systems and regulatory requirements. Knowledge of legal, regulatory and policy compliance issues related to medical coding and billing procedures and documentation.
• Excellent communication and interpersonal skills and demonstrated ability to interact with a variety of team members.
• Self-motivated with the ability to identify opportunities for improvement and demonstrate the initiative to resolve issues in support of improvement efforts.
• Strong analytical skills and the ability to work independently to analyze and solve problems.
• Adept at learning proprietary software applications.
• Collaborate with professionals internal and external to the company and across geographic locations
• Exhibit growth mindset and team-orientated behaviors
• Navigate competing priorities and effectively work in a fast-paced environment