Code And Documentation Compliance Specialist:Cfhp

University Health; Texas; On-site; USD 60,000 - 85,000; Full time

Job summary

University Health in Texas is seeking an experienced Coding Specialist to join the SIU team to support investigations, detailed coding audits, and data-driven reporting. You will work under the SIU Manager and apply advanced coding skills to improve accuracy and compliance.

The role includes research on eligibility, claims payment, benefits, prior authorizations, and contract review, plus education programs for staff and physicians on findings from audits and investigations.

Qualifications

• High school diploma or equivalent required.
• Five years' experience with ICD-10-CM/DRG, chart auditing, and CPT4 coding; or two years with a certified coding program.
• Knowledge of ICD-10 and Microsoft Office products.

Responsibilities

• Conduct administrative investigations related to fraud and abuse.
• Research eligibility, claims payment, benefits, prior authorization/referrals and contract review.
• Audit coding and documentation to ensure compliance with federal and state laws and regulations.
• Identify overpayments to providers and assist with the anti-fraud program.
• Conduct routine education programs for staff and physicians on investigations and audits.

Skills

ICD-10-CM/DRG

CPT4 coding

Chart auditing

Data reporting

Microsoft Office

Education

High school diploma

Certified Coding Program or Health Information Management program

Tools

Microsoft Office

Job description

POSITION SUMMARY/RESPONSIBILITIES

Functions under the direct supervision of the Special Investigations Unit (SIU) Manager. Performs at the advanced skill level of a Coding Specialist. Is adept at data collection and statistical report generation. Demonstrates individual judgement, initiates work improvement methods. Will conduct administrative investigations related to fraud and abuse. Will conduct research related to eligibility, claims payment, benefits, prior authorization/referrals and contract review. Responsible for conducting and reviewing audits to assess the quality of coding and documentation to ensure compliance with federal and state laws and regulations. Responsible for researching and compiling documentation that may be reported to external regulatory and law enforcement agencies. Research and audit for accurate provider and facility payments. Identifies overpayments to provider. Assists provider, employee and contractors with the Community First Health Plan's anti-fraud program. Conducts routine education programs for staff and physicians to communicate findings from investigations, coding and documentation audits.

EDUCATION AND EXPERIENCE

High school diploma or its equivalent is required. Five years of experience with ICD-10-CM/DRG assignment, chart auditing, and CPT4 code assignment is required or only two years of experience if candidate has successfully completed a Certified Coding Program or Health Information Management Program. Must be knowledgeable of ICD-10. Must be knowledgeable of Microsoft Office products.