Medical Coding Compliance Specialist

Medical Mutual of Ohio

405d

About The Position

The Medical Coding Compliance Specialist is responsible for optimizing and reviewing documentation for risk adjustment coding related to the Affordable Care Act (ACA) and Medicare Advantage (MA). This role involves auditing medical records, ensuring adherence to coding guidelines, and supporting Risk Adjustment Data Validation (RADV) audits. The specialist will also provide coding expertise to internal departments and assist in maintaining coding proficiency through continuing education.

Requirements

• Bachelor's Degree in Healthcare Administration or related field, or equivalent experience.
• 1-2 years clinical coding experience for Medical Coding Compliance Specialist I; 3 years for Specialist II.
• Experience in auditing medical records is preferred.
• Certification from AAPC (CPC) or AHIMA (RHIT, CCS) is required.
• Demonstrated proficiency in ICD and CPT coding.
• Ability to read and interpret medical coding regulations.
• Basic knowledge of hospital and provider operations related to medical coding.

Nice To Haves

• CRC (Certified Risk Adjustment Coder) or other industry recognized certifications.
• Extensive knowledge of hospital and provider operations as it applies to medical coding.
• In-depth knowledge of Electronic Medical Record systems.

Responsibilities

• Optimize and review documentation for risk adjustment coding for ACA and MA.
• Evaluate requests for adherence to company policies for precise medical codes.
• Conduct initial retrospective chart audits and document discrepancies.
• Code and recheck all diagnoses and procedures using ICD-CM and CPT-4 codes.
• Support RADV audits required by CMS for ACA and MA Risk Plans.
• Attend continuing education classes to maintain coding proficiency and certification requirements.
• Respond to coding inquiries from various internal departments.
• Collaborate on projects requiring coding expertise.

Benefits

• Employee bonus program.
• 401(k) with company match up to 4% and additional contributions.
• Health Savings Account with company matching contribution.
• Excellent medical, dental, vision, life, and disability insurance.
• Access to an Employee Assistance Program.
• Company holidays and up to 16 PTO days in the first year.
• Parental leave for eligible employees after 120 days of service.
• Tuition reimbursement up to $5,250 per year.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree
• Number of Employees: 10,001+ employees