Medical Coding Compliance Specialist

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Theoria Medical

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Healthcare Insurance • SaaS • Telecommunications

Theoria Medical is a leader in tech-enabled, value-based primary care, revolutionizing healthcare for senior living communities nationwide. The company employs a fully integrated model of care, combining primary care services with the latest technological advancements to offer a holistic and impactful healthcare experience for seniors. Their innovative offerings include remote patient monitoring, medical directorship, on-site medical staff, telemedicine, and workflow optimizations, all anchored by pioneering technologies like ChartEasy, ChatEasy, and ProphEasy. Theoria Medical is committed to enhancing patient outcomes through digital innovation and serves patients in skilled nursing, assisted living, and independent living settings across the United States.

1001 - 5000 employees

⚕️ Healthcare Insurance

☁️ SaaS

📡 Telecommunications

📋 Description

• 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.

🎯 Requirements

• 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.

🏖️ Benefits

• 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.