United States onlyMedical Coding Compliance Specialist
Compensation: Up to $85,000 annually, determined by your experience and qualifications.
Job Location:Remote (US)
Job Highlights:
- Work-Life Balance: Monday to Friday schedule for a fulfilling personal and professional life.
- Competitive Compensation: Be rewarded with a generous salary and benefits package.
- Career Growth Opportunities: Unlock your potential and advance in your career with our support.
- Supportive Work Environment: Join a team that values and appreciates your contributions.
- Comprehensive Training: Enhance your skills and knowledge through our extensive training programs.
- Compliance and Peace of Mind: Work with confidence knowing that we prioritize compliance with employment laws and regulations.
- Paid Time Off and Holidays: Enjoy well-deserved time off to relax and recharge.
- Life Insurance Coverage: Protect your loved ones with our employer-paid life insurance policy.
- Collaborative Team Environment: Thrive in a positive and collaborative work environment.
Company Overview
Theoria Medical is a comprehensive medical group and technology company dedicated to serving patients across the care continuum with an emphasis on post-acute care and primary care. Theoria serves facilities across the United States with a multitude of services to improve the quality of care delivered, refine facility processes, and enhance critical relationships. We offer a broad scope of services including multispecialty physician services, telemedicine, remote patient monitoring, and more. We currently operate primary care clinics and provide medical services to skilled nursing facilities in numerous states across the nation.
As a leading edge, innovative, and quality driven physician group, we continue to expand nationally. In pursuit of this, we continue to seek talented individuals to join our amazing team and care for our population. We wish to extend a warm welcome to all candidates interested in making a difference in healthcare delivery by joining the Theoria team
We are currently seeking skilled professionals to join our Legal Department. The successful candidates will support the legal team in contract drafting (including NDAs, contractor agreements, vendor agreements, and employment agreements), legal research, healthcare regulatory compliance, and general legal assistance.
The Medical Coder Compliance Specialist is responsible for ensuring the organization's medical coding and billing practices are in full compliance with federal and state regulations, as well as with payer and coding guidelines. This role involves performing independent audits, conducting training for medical staff, and acting as a subject matter expert on coding and documentation standards.
Key Responsibilities
Conduct coding audits: Perform reviews of medical record documentation and coding to ensure accuracy, completeness, and adherence to regulatory requirements and coding guidelines (e.g., ICD-10-CM, CPT, HCPCS).
Identify and mitigate risks: Analyze audit data to identify trends, potential compliance risks, and areas for improvement. Recommend and implement corrective action plans.
Provide education and training: Develop and deliver educational programs, presentations, and one-on-one training sessions for physicians, and other staff on coding best practices and compliance issues.
Stay up to date on regulations: Maintain expert knowledge of evolving federal and state regulations, CMS guidelines, and industry coding standards. Research and interpret new rules and policies.
Respond to inquiries: Serve as a resource for internal and external questions related to coding, billing, and documentation compliance.
Prepare reports: Document audit findings and present clear, concise reports to management, explaining risk areas and compliance issues.
Investigate issues: Conduct investigations into potential non-compliant activities or billing discrepancies to determine root causes and recommend solutions.
Collaborate across departments: Work closely with billing, revenue cycle management, and clinical departments to ensure seamless and compliant workflows.
Required qualifications:
Certification: Relevant, industry-recognized coding certification such as Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Professional Medical Auditor (CPMA) or equivalent.
Education: An associate or bachelor’s degree in health information management or related field preferred but not required.
Experience: A minimum of 5 years of experience in medical coding and auditing. Experience in professional services for Evaluation and Management coding, Chronic Care Management, and Risk Adjustment coding.
Knowledge: Extensive knowledge of CPT, ICD-10-CM, and HCPCS coding systems, as well as Medicare and Medicaid regulations, is essential.
Key skills
Analytical skills: The ability to perform root cause analysis, identify trends, and analyze complex information with meticulous attention to detail.
Communication: Excellent verbal, written, and presentation skills to effectively communicate complex coding and compliance concepts to both clinical and non-clinical staff.
Problem-solving: A proactive and objective approach to problem-solving and an ability to gain acceptance of recommended solutions.
Integrity: A high degree of integrity and the ability to maintain confidentiality with sensitive patient information.
Employee must be able to perform the essential functions of this position satisfactorily, with or without a reasonable accommodation. Employer retains the right to change or assign other duties to this position.
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