Coding & Documentation Compliance Specialist

Corporate Square; San Antonio (TX); On-site; USD 50,000 - 70,000; Full time

Job summary

A leading healthcare organization is seeking an experienced Coding Specialist to join its Special Investigations Unit in San Antonio. The role involves auditing and investigating coding compliance while providing education to staff and assisting with anti-fraud programs. Candidates should have a high school diploma, relevant coding experience of five years, or two years if they possess a certification.

Qualifications

• Five years of experience with ICD-9-CM/DRG assignment and chart auditing.
• Knowledgeable of ICD-10 and Microsoft Office products.
• At least two years of experience if completed a coding program.

Responsibilities

• Conduct administrative investigations related to fraud and abuse.
• Responsible for conducting and reviewing audits for coding compliance.
• Educate staff and physicians on findings from audits.

Skills

Data Collection

Statistical Report Generation

Coding Compliance

Research

Auditing

Education

High School Diploma or equivalent

Certified Coding Program

Health Information Management Program

Tools

ICD-9-CM

CPT4

ICD-10

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-9-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.