[Hiring] Medical Coding Compliance Specialist @Theoria Medical

Role Description

We are currently seeking a Medical Coding Compliance Specialist to support coding accuracy, regulatory compliance, and clinical documentation integrity across the organization.

• Conduct Coding Audits
  • Perform detailed reviews of medical record documentation and coding to ensure accuracy, completeness, and compliance with ICD-10-CM, CPT, HCPCS, and payer guidelines.
• Identify and Mitigate Risks
  • Analyze audit findings to identify compliance trends, risks, and opportunities for improvement.
  • Recommend and support corrective action plans.
• Provide Education and Training
  • Develop and deliver educational sessions and one-on-one guidance for physicians and staff regarding coding best practices and compliance standards.
• Stay Up to Date on Regulations
  • Maintain current knowledge of CMS guidelines, federal and state regulations, and industry coding standards.
  • Research and interpret new coding and billing policies.
• Respond to Inquiries
  • Serve as a resource for coding, billing, and documentation compliance questions across departments.
• Prepare Reports
  • Document audit findings and prepare clear, concise reports for leadership outlining risks and recommendations.
• Investigate Compliance Issues
  • Conduct investigations into potential non-compliant activities or billing discrepancies and assist in identifying root causes and solutions.
• Collaborate Across Departments
  • Partner closely with billing, revenue cycle management, providers, and operational teams to support compliant and efficient workflows.

Qualifications

• Minimum of 5 years of experience in medical coding and auditing.
• One or more of the following certifications is required:
  • Certified Professional Coder (CPC)
  • Certified Coding Specialist (CCS)
  • Certified Professional Medical Auditor (CPMA)
  • Equivalent industry-recognized certification
• Associate’s or Bachelor’s degree in Health Information Management or a related field preferred, but not required.
• Experience with Evaluation and Management (E/M) coding, Chronic Care Management (CCM), and Risk Adjustment coding preferred.
• Extensive knowledge of CPT, ICD-10-CM, and HCPCS coding systems.
• Strong understanding of Medicare and Medicaid regulations and compliance standards.
• Strong analytical and problem-solving abilities.
• Excellent written, verbal, and presentation communication skills.
• High attention to detail and organizational skills.
• Ability to maintain confidentiality and professionalism with sensitive patient information.

Benefits

• Paid Time Off
• 401(k) with employer matching and participation
• Medical, vision, and dental insurance for eligible candidates
• Short and long-term disability insurance for eligible candidates
• Employer-paid life insurance policy
• Technology and tools designed to streamline workflows and improve efficiency