Coding Compliance Specialist - HM

Paylocity; Atlanta, Northern (GA, KY); Hybrid; USD 55,000 - 75,000; Full time

Job summary

Core Clinical Partners is seeking a Coding Compliance Specialist to extract clinical information from EMR systems, analyze documentation, and ensure proper CPT billing assignments per CMS guidelines. The role emphasizes patient-centric care and regulatory compliance.

You will assign ICD-10, CPT, and HCPCS codes, validate accuracy, and stay current with coding standards. Remote work with travel for meetings is required.

Qualifications

• Bachelor’s degree or equivalent is required.
• Preferred: RHIA, CDI, CPC, CCS, CCS-P credentials.
• 1–2 years’ experience in hospital or physician practice environment.
• Experience with Evaluation & Management coding; EM/Hospital medicine background preferred.
• EHR/EMR experience required.
• Chart Auditing/Optimization experience preferred.

Responsibilities

• Review and analyze medical records for inconsistencies and remediation.
• Assign ICD-10, CPT, and HCPCS codes based on documentation.
• Validate code accuracy and adherence to guidelines and regulations.
• Maintain up-to-date knowledge of coding standards and payer policies.
• Perform audits of coded records to ensure accuracy and compliance.
• Provide recommendations for coding improvements and best practices.
• Review new business records for documentation opportunities and templating education.
• Utilize coding software and EHR systems efficiently.

Skills

Medical coding

ICD-10 coding

CPT coding

HCPCS coding

EHR/EMR

Documentation analysis

Regulatory know-how

Audit & QA

Communication

Team collaboration

Education

Bachelor’s degree or equivalent

RHIA

CDI

CPC

CCS

CCS-P

Tools

EHR/EMR

Job description

Description

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 ongoing 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

Requirements

Education:

• Bachelor’s degree or equivalent is required
• Preferred: RHIA, CDI, CPC, CCS, CCS-P

Experience:

• 1-2 years’ experience in Hospital or Physician practice environment desired.
• Experience with Evaluation & Management coding; emergency medicine/hospital medicine background preferred.
• EHR/EMR (Electronic Health Record/Electronic Medical Record) experience required.
• Chart Auditing/Optimization experience preferred

Work Location:

• Remote work with travel for in-person meetings and events. The employee must have reliable access to internet.

Core Clinical Management, LLC is an equal opportunity employer and complies with ADA regulations as applicable.?

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.