Coding Quality Specialist - Remote

Overview

The Coding Quality Specialist evaluates the adequacy and effectiveness of internal and operational controls designed to ensure that coding processes and practices lead to appropriate execution of regulatory requirements and guidelines related to facility coding.

In Short

• Evaluate coding accuracy and compliance with regulations.
• Apply standardized scoring methodology for coding reviews.
• Communicate results to management and coders.
• Conduct risk assessments and define monitoring priorities.
• Perform retrospective and prospective coding reviews.
• Evaluate appropriateness of ICD-10, HCPCS, and CPT codes.
• Prepare written reports of findings and recommendations.
• Research coding rules and regulations.
• Serve as a subject matter expert on coding standards.
• Maintain effective working relationships with team members.

Requirements

• High School Diploma or GED equivalent.
• Three years of related work experience.
• Ability to analyze and solve complex problems.
• Effective communication skills in written and verbal formats.
• Knowledge of DRG/APC reimbursement and health information systems.
• Familiarity with medical terminology and anatomy.
• Knowledge of coding conventions for ICD-10-CM & CPT-4.
• CCS, RHIT, RHIA, CPC, or CCSP certification required.
• Ability to work effectively as a team player and leader.
• Ability to manage and prioritize multiple tasks.

Benefits

• Competitive salary and benefits package.
• Opportunities for professional development.
• Supportive work environment focused on patient care.
• Diversity and inclusion initiatives.
• Access to advanced medical resources and technology.