Coding Compliance Specialist

7 days left

Laurel, Maryland
May 05, 2023
Jun 04, 2023
IT, QA Engineer
Full Time

ERP International is seeking a Coding Compliance Specialist for a full-time position, supporting the Department of Defense. Apply online today and discover more about this outstanding practice opportunity.

Be the Best! Join our team of exceptional health care professionals across the nation. Come discover the immense pride and job satisfaction ERP Employees experience in providing care for our Military Members, their Families and Retired Military Veterans! ERP International is honored to have been named one of The Washington Post's 2022 Top Workplaces!

* Excellent Compensation & Exceptional Comprehensive Benefits!
* Paid Time Off and Paid Federal Holidays!

* Medical/Dental/Vision, LTD/STD/Life, and Health Savings Account available, and more!
* Annual CME Stipend and License/Certification Reimbursement!

* Matching 401K!

About ERP International, LLC: ERP is a nationally respected provider of health, science, and technology solutions supporting clients in the government and commercial sectors. We provide comprehensive enterprise information technology, strategic sourcing, and management solutions to DoD and federal civilian agencies in 40 states. Founded in 2006, ERP is headquartered in Laurel, MD and maintains satellite offices in Montgomery, AL and San Antonio, TX - plus project locations nationwide. ERP is an Equal Opportunity Employer - Disability and Veteran.


Work Schedule:

M-F, 7:30 to 4:30 PM

No weekend

No holidays

Knowledge and Skills

Candidates must possess the following knowledge:
  • Advanced Knowledge of the International Classification of Diseases, Clinical Modification (ICD-CM), and Procedural Coding System (PCS); Healthcare Common Procedure Coding System (HCPCS); and Current Procedural Terminology (CPT)
  • Advanced knowledge of reimbursement systems, including Prospective Payment System (PPS) and Diagnostic Related Groupings (DRGs); Ambulatory Payment Classifications (APCs); and Resource-Based Relative Value Scale (RBRVS)
  • Advanced knowledge of anatomy, physiology, disease processes, medical and surgical procedures, and medical terminology, including accepted medical abbreviations to perform the full scope of inpatient coding, including inpatient discharges, surgical cases, diagnostic studies and procedures, and inpatient professional services and facility encounters.
  • Advanced knowledge of medical coding processes, procedures, regulations, guidelines, and principles to complete routine and non-routine medical record examination and coding tasks.
  • Skill in examining and extracting written and numerical data from medical documentation, to draw conclusions and generate reports based on factual documentary evidence to apply appropriate codes and identify documentation inconsistencies.
  • Ability to utilize medical computer software programs to abstract, analyze, and/or evaluate clinical documentation and enter/edit diagnosis and procedure codes.
  • Ability to communicate clearly and effectively, verbally and in writing, problems, conclusions, and coding guidance to individuals and groups at a variety of levels; defining target audiences and tailoring communications and messaging to target audience.
  • Advanced ability to define target audiences and tailor communications and messaging to target audience.
  • Ability to develop new insights into situations and applies new solutions to problems, working with others to develop, test, and implement new ideas, innovations, and methods to continuously improve coding accuracy and clinical documentation.
  • Ability to perform numerical calculations necessary for analysis of data; identify, analyze, and interpret trends or patterns in complex data sets; scope and statistical sampling methodologies; and quality assurance and coding risk analysis concepts.
  • Advanced knowledge of medical specialties; medical diagnostic and therapeutic procedures; ancillary services (includes, but is not limited to, Dental, Laboratory, Occupational Therapy, Physical Therapy, and Radiology); and revenue cycle management concepts.
  • Advanced knowledge of Compliance program requirements and/or initiatives (ex. HIPAA violations and fraud, documentation guidelines, and billing guidelines).
  • Thorough understanding of Government rules and regulations regarding medical coding, reimbursement guidelines, and healthcare fraud; commercial reimbursement guidelines and policies; coding audit principles and concepts, and potential areas of risk for fraud and abuse. Includes, but is not limited to: The Federal Register, Center for Medicare, and Medicaid Services (CMS) Local Coverage Determinations and National Coverage Determinations (LCD and NCD), National Correct Coding Initiative (NCCI) guidance, manual, and edits, Internet-Only Manuals (IOMs), and HHS-OIG publications and reports.
  • Intermediate knowledge of auditing concepts and principles.
  • Understand and interpret written material, including technical material, rules, regulations, instructions, reports, charts, graphs, or tables; applies what is learned from written material to specific situations.
  • Write in a clear, concise, organized, and convincing manner for the intended audience; use correct English grammar, punctuation, and spelling; communicate information (for example, facts, ideas, or messages) in a succinct and organized manner; produce written information, which may include technical material, that is appropriate for the intended audience.
  • Clearly express information (for example, ideas or facts) to individuals or groups effectively, taking into account the audience and nature of the information.
  • Practical knowledge and understanding of training concepts, methods, and techniques.
  • Intermediate ability to leverage virtual technologies to effectively communicate with remote audiences.
  • Intermediate ability to assist with development of online training courses.
  • Advanced knowledge of revenue cycle management, training methods, clinical documentation improvement, and continuous process improvement processes.
  • Practical knowledge of project management concepts, business analysis, and CDM concepts and guidance, to include the National Uniform Billing Committee (NUBC) Official UB-04 Data Specifications Manual.
  • Practical knowledge of Current Dental Terminology (CDT).
  • Assist leadership in managing and reducing compliance risks. Conduct investigations and audits to identify areas of risk, draft a plan for improving compliance practices to address those risks, and monitor to ensure the medical coding program is following best practices and standards. Apply analytical, investigative, and decision-making skills in investigating reports of organizational non-compliance, independently and objectively determining facts and findings, and making recommendations for corrective actions, to include follow-up to ensure corrective actions have resolved the root cause of the non-compliance. Analyze metrics and reporting data to identify, report, and develop mitigation courses of action for risks to the organization. Stay abreast with the U.S. healthcare compliance laws, regulations, and enforcement environment in regards to medical coding and documentation, and understand how they impact the organization. Encourage a zero-tolerance environment where fraud or non-compliance is unacceptable. The work involves providing business and cost analysis support services that reflect relevant guidance, policy, regulations, rules, or standards in developing position papers, presentations, or other documents, and present recommendations verbally or in writing to the DHA MCPB or varying levels of DHA leadership. Investigations are completed within timeline defined in investigation scope document.
  • Monitor, track, trend, and report on organizational compliance with Federal, DoD, DHA, and industry regulatory requirements in regards to medical coding and documentation. Collect, organize, analyze, and disseminate significant amounts of data. Collect information and provide a variety of reports and analyses to monitor and evaluate projects and programs. Conduct regular review of policies, training, and communications, and other components of the coding compliance program to ensure continuous improvement. Perform due diligence in ethically and appropriately researching and/or interpreting existing coding guidance, policy, regulations, rules, or standards, including seeking clarification from the DHA-MCPB. Analyze enterprise coding metrics, indicators, audit results, and other data in order to assist in development of an annual enterprise risk assessment and work plan. The work involves examining enterprise data and documentation, assisting in implementing any new requirements in Federal laws, Department of Health and Human Services Office of Inspector General (HHS-OIG), DoD, and DHA instructions, policies, and regulations, and commercial policies involving or affecting compliance. Assist with developing, editing, maintaining, and updating coding compliance plans.
  • Provide guidance to organization members on the organization's medical coding compliance policies and programs, and also educate staff on applicable medical coding compliance rules, regulations, and best practices. Lead, coordinate, and/or participate in Market Coding Compliance committee meetings to discuss Market risks, investigations, issues, and other matters impacting medical coding and documentation. Responsible for the preparation of compliance presentations and reports such as incident and training metrics.
  • Maintain current knowledge of the Charge Description Master (CDM), clinical charging procedures, and related systems for the production of a bill/claim in MHS systems. The task involves monitoring changes and updates to the CDM, including but not limited to: line items, revenue codes, Current Procedural Terminology (CPT) and/or Healthcare Common Procedure System (HCPCS) codes, and other components of a CDM line item that may have an impact on DHA coding.
  • Collaborate with medical coding trainers, auditors, and production coding staff by providing guidance and communication on correct change capture and coding processes. Analyze changes to coding and billing rules and regulations by utilizing appropriate reference materials, internet sources, seminars, and publications. Respond to coder or provider questions as necessary and provides examples of appropriate coding and documentation reference(s) to provide clarity and understanding. Based on contacts from the medical staff, identify training opportunities and work with coding training personnel to focus on consistency and clarity of coding advice provided.
  • Evaluate controls, processes, systems, and workflows impacting revenue capture to identify root causes of erroneous coding, lost revenue, revenue leakage, and service wastes. Analyze and trend claim edit issues for root cause resolution to include charge master corrections, product line charge description master (CDM) education, coder education or other process improvements. Prepare reports as required by management regarding audit results, process improvement recommendations, and systemic coding errors. Evaluate current charging and coding structures and processes in clinical departments to ensure appropriate capture and reporting of revenue and compliance with government and third-party payer requirements. Assist the DHA-MCPB with revenue integrity initiatives.
    • The work involves communicating by phone, electronically, and in person with Market and/or MTF leadership and staff, analyzing and investigating current processes and workflows through use of task analysis and other methodologies to identify bottlenecks, service wastes, and other opportunities for improving cost savings and/or revenue capture.
      The work includes developing and recommending cost effective solutions to leadership that eliminates non-compliance with official coding policies and eliminates or mitigates revenue loss, and revenue leakage at the problem source.
      The work typically involves the development, proposal, and (upon DHA-MCPB approval) execution of a project on a specific compliance issue or topic, including but not limited to project management artifacts such as work breakdown structure, resource budget, timeline, report and findings, corrective actions, and project return on investment (ROI). Projects are completed within timelines defined in project plan and scope document.
  • When directed, perform targeted audits of specific DHA Markets, DHARs, MTFs, medical service lines or specialties, or DHA GS or Contractor personnel, according to the scope document that will be provided by the DHA-MCPB for the targeted audit.
  • Professionally interact with Market and/or MTF staff and other coders from different companies regarding coding and documentation rules, policies, procedures, and regulations. Obtain clarification of conflicting, ambiguous, or non-specific documentation. Provide advice, assistance, and technical support to Market and/or MTF staff, Medical Coders, reviewers, Medical Coding Auditing Specialists, and Medical Coding Trainers as appropriate regarding official coding guidance and regulatory provisions.

Additional skills:
  • Make well-informed, effective, and timely decisions, even when data are limited, or solutions produce unpleasant consequences; perceives the impact and implications of decisions.
  • Receive, attend to, interpret, and respond to verbal messages and other cues such as body language in ways that are appropriate to listeners and situations.
  • Clearly express information (for example, ideas or facts) to individuals or groups effectively, taking into account the audience and nature of the information.
  • Utilize medical computer software programs to abstract, analyze, and/or evaluate clinical documentation and enter/edit diagnosis and procedure codes.
  • Write in a clear, concise, organized, and convincing manner for the intended audience; use correct English grammar, punctuation, and spelling; communicate information (for example, facts, ideas, or messages) in a succinct and organized manner; produce written information, which may include technical material, that is appropriate for the intended audience.
  • Display courtesy, empathy, and tact, while developing and maintaining effective relationships with others; effectively work with individuals who are difficult, hostile, or distressed to resolve differences; and be able to relate well to people from varied backgrounds and in different situations.
  • Work with internal and external customers to assess their needs, provide information or assistance, resolve their problems, or satisfy their expectations.
  • Contribute to maintaining the integrity of the organization; display high standards of ethical conduct and understand the impact of violating these standards on an organization, self, and others.
  • Be open to change and new information; adapt behavior or work methods in response to new information, changing conditions, or unexpected obstacles; effectively deals with uncertainty.
  • A high level of effort and commitment towards performing the work, using efficient learning techniques to acquire and apply new knowledge and skills; use training, feedback, or other opportunities for self-learning and development.
  • Understand and interpret written material, including technical material, rules, regulations, instructions, reports, charts, graphs, or tables; apply what is learned from written material to specific situations.
  • Attention to detail and completeness with a thorough understanding of government rules and regulations, medical coding and reimbursement guidelines, and potential areas of risk for fraud.
  • Use imagination to develop new insights into situations and apply new solutions to problems; assist in designing new methods where established methods and procedures are not suitable or are unavailable.



A minimum of one of the following:
  • An Associates Degree in Health Information Management or Healthcare Administration or biological science.
  • A university, college, or technical school certificate in medical coding.
  • At least 30 semester hours relevant university/college credit of a grade of C, Pass, or better that includes relevant coursework suck as anatomy/physiology, medical terminology, health information management, and/or pharmacology.
  • Completion of An AAPC or AHIMA online or in person coding exam preparation course that includes medical terminology, anatomy, and physiology, health information management concepts, and pharmacology.
  • Completion of a training course beyond apprentice level for medical technicians hospital, corpsmen, medical service specialists, or hosptial training, obtained in a training program given by the Armed Forces or hte US Maritime Service under close medical and professional supervision.

License/Certification and Training:Must possess and maintain both Professional Services and Institutional (Facility) Coding Certifications.
  • Professional Services Coding Certifications (one of the followng): RHIT, RHIA, CPC, or CCS-P
  • Instituional (Facility) Coding Certifications (one of the followng): CIC, CCS, RHIT, or RHIA
  • Coding Compliance Certificates (one of the followng): CPCO through AAPC or CHC through HCCA
  • Evaluation and Management Auditing Certificate: CEMA through NAMAS
  • Additional Desirable or Preferred Coding Certificates: CPMA through AAPC and CHRI through NAHRI
  • Continuing Education Requirements: Auditors shall maintain the required continuing education to keep certifications current at all times

NOTE: The AHIMA RHIT or RHIA credential may be counted towards either the professional services or institutional coding certification requirement, but not both unless the individual possesses the required institutional AND professional services experience for the specific position sought.


Candidates must meet all of the following:
  • A minimum of ten years of medical coding and/or auditing experience in two or more medical, surgical, and ancillary specialties within the past 15 years, including at least five (5) years of experience in an auditing, training, or compliance role, or
  • A minimum of three (3) years of auditing, training, and/or compliance experience within the last six (6) years in a military coding environment.
    • When claiming medical coding experience, a minimum of one (1) year of performance in the specialty is required to be qualifying. Multiple specialties encompass different medical specialties (i.e., Family Practice, Pediatrics, Gastroenterology, OB/GYN, etc.) that utilize ICD, E&M, CPT, and HCPCS codes. Ancillary specialties (PT/OT, Radiology, Lab, Nutrition, etc.) that usually do NOT use E&M codes do not count as qualifying experience. Coding experience limited to making codes conform to specific payer requirements for the business office (insurance billing, accounts receivable) is not a qualifying factor.
    • When claiming training experience, training expertise must include identifying coding training opportunities; developing training plans and material, and instruction/delivery of the training to medical coder and clinical audiences.
    • Coding, auditing, and training exclusively for specialties such as home health, skilled nursing facilities, and rehabilitation care will not be considered as qualifying auditing experience.
    • When claiming compliance experience, compliance functions include identifying compliance issues and analyzing practice patterns and recommending changes to policies and procedures; recommending/updating standard policies and procedures; contribute to risk assessments and mitigation strategies; and data collection and statistical report generation.

  • Must be able to obtain government clearance.