Coding Compliance Specialist

Coding Compliance Specialist

Full-Time | Hourly 

La Clinica Center for Learning and Innovation 

We’re committed to compassionate care for all. Our patients. Our employees. You. 

At La Clinica, we love our patients and enthusiastically treat them with the same care, respect, and dignity that we would our friends, family, and neighbors because that's who they are. If this appeals to you, La Clinica might be the right place to build your career. We’re looking for the right team members to treat our patients with this level of care. 

We extend our commitment to compassionate care to our employees as well. We invest in our employees' lives through competitive pay, comprehensive benefits packages, easy access to wellness, personal and professional development workshops, and a focus on healthy work-life harmony. Check out our careers page to learn more about why our employees love working at La Clinica. 

The Coding Compliance Specialist’s primary job function is to maintain organizational compliance with coding and medical record documentation. The Coding Compliance Specialist is responsible for reviewing the coding of professional service records for compliance with CMS, AMA and certified coding standards. This position will conduct internal chart audits, encounter form reviews, assist with teaching providers/staff coding, and reporting results. This position will support any third-party billing staff in areas related to coding and/or collections. Utilizes advanced knowledge of specialty coding to analyze patient medical records, ensuring that documentation by providers conforms to legal and procedural requirements. 

Accountabilities Include: 

• Ensure that medical claims are submitted accurately and in a timely manner. 
• Review electronic health record to assign accurate ICD-10-CM and CPT/HCPCS codes based on coding principles and official guidelines. 
• Reviews patient records documentation to ensure that services provided are accurate and meet appropriate guidelines. 
• Monitors billing performances to ensure optimal reimbursement while adhering to regulations prohibiting unbundling and other questionable practices. 
• Utilizes advanced, specialized knowledge of medical codes and coding procedures to assign and sequence appropriate diagnostic/procedure billing codes, in compliance with third party payer requirements. 
• Interacts with physicians and other patient care providers regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentation. 
• Reviews and resolves the claim edit and charge review work queues. 
• Enter out-patient/hospital physician/non-physician practitioner services through review of medical records/encounter forms or EHR records. Will also review recipient identification to assure correct patient. 
• Provides feedback and education regarding identified deficiencies to providers and clinical staff. 
• Serves as a resource person to providers, clinical, and coding staff on problems related to coding. 
• Assists in developing, implementing, and processing a coding compliance education/training program for physicians, on-physician providers, and new providers. 
• Processes rebilling’s as requested/required by insurance rejections for coding errors. 
• Assures compliance with all regulatory agencies and payor sources. 
• Conducts quarterly compliance auditing and monitoring for all payors. Creates summary of findings to report to leadership with solutions to address issues with employees. 
• Communicates with providers and clinical coordinators/team leads regarding new regulatory guidelines for billing and documentation compliance. 
• Assures that providers and support staff understand their responsibility for accuracy of coding of encounters. 
• Leads or assists in developing education programs for providers around coding. 
• Acts as a liaison between physicians and clinical staff to resolve issues involving coding and documentation requirements and procedures. 
• Research inquiries from providers and patients related to coding, reimbursements, and denials. 
• Responds to inquiries regarding CPT, HCPCS and ICD-10 coding. 
• Acts as a liaison between the medical coordinators, members of senior leadership, and the coding department. 
• Works with OCHIN billing service to remedy coding issues. 
• Interacts with department heads and other administrative staff regarding implementation of new codes and revision of charge documents. 
• Complies with patient records policies and procedures such that patient data is handled in a strictly confidential manner; protected from loss, tampering, destruction, or unauthorized disclosure. 
• Ensures the integrity of the HCPCS, CPT and ICD-10 codes are maintained in the electronic health record (EHR). 
• Follows established departmental policies, procedures, and objectives, continuous quality improvement objectives, and safety and environmental standards. 
• Attends coding conferences, workshops, and in-house sessions to receive updated coding information and changes in coding and/or regulations. 
• Maintains fee schedules and provider master file. 
• Participates in OCHIN Billing Workgroup. Acts on information and communicates changes as appropriate. 
• Maintains current coding credentials and knowledge of state and federal regulations applicable to coding. 

Qualifications: 

Must be able to interact with a variety of individuals at various levels under stressful circumstances while exercising sound judgement, tact, and diplomacy; work productively both independently and in a team setting; communicate with clarity, both verbally and in writing to groups and individuals. 

Education and/or Experience: 

Required: 

• Minimum: High School Diploma or GED equivalent. 
• Certification in ICD-10, CPT and HCPCS coding is required. 
• Minimum one year experience working with Electronic Health Record and specialty coding with one to three years’ experience directly related to the duties and responsibilities field. 
• Excellent interpersonal communication and problem-solving skills. 
• Skills to intervene and promote reconciliation, compromise and positive outcomes in difficult interactions. 
• Skilled at using electronic health records as applicable to area of work (EPIC, Wisdom). 

Preferred: 

• Additional education and training are desirable with two years medical office experience and training; billing experience and chart auditing experience preferred. Community health care experience preferred. 
• Basic knowledge of adult learning models. 

Equity Statement:  

At La Clinica, we commit to engage everyone in a welcoming, respectful, and loving way and to maintain the dignity and value of all people above everything else. These standards align with our organization’s vision of absolute excellence, open-hearted community, and well-being for all.  

For more information, please visit our website at: https://laclinicahealth.org/patients/approach/  

Applications will be reviewed by the appropriate Department for interview; those selected must be able to provide proof of legal right to work in this country. La Clinica is a drug free work environment. Equal Opportunity Employer. La Clinica complies with the Americans with Disabilities Act. If you consider yourself disabled and desire assistance in the application process, please contact the Human Resources Department.