Coding Compliance Specialist

About the position

The Coding Compliance Specialist at Johns Hopkins Health Plans plays a crucial role in ensuring accurate coding and compliance within the healthcare system. This position involves reviewing appeals from providers, collaborating with various teams to rectify coding issues, and monitoring annual code changes. The specialist will also provide guidance on coding matters and contribute to the overall improvement of healthcare delivery.

Responsibilities

• Review appeals from providers and ensure benefits are applied correctly through the system.
• Collaborate with Operations and Provider Relations teams to fix incorrect coding issues.
• Overturn or uphold decisions based on the review of appeals content from providers.
• Monitor annual code changes implemented by governing bodies.
• Provide guidance on coding issues to department management and staff.

Requirements

• CPC or AAPC Certification is required.
• 1+ years' experience in coding/auditing.
• 5+ years' medical claims or related insurance experience.
• Requires an AA degree in Business, Health Care Administration or related field.
• Bachelor's degree preferred.
• Strong familiarity with healthcare regulatory requirements and medical plans.

Nice-to-haves

• Effective oral and written communication skills.
• Knowledge of reimbursement methodologies and guidelines.

Benefits

• 403(b)
• Dental insurance
• Health insurance
• Paid holidays
• Paid time off
• Tuition reimbursement
• Vision insurance