Overview We are seeking a highly skilled and detail-oriented Certified Professional Coder & Coding Compliance Specialist to join our Revenue Cycle Management team. This pivotal role involves ensuring accurate medical coding, adherence to regulatory standards, and maintaining compliance with healthcare policies. The ideal candidate will possess extensive knowledge of CPT coding, ICD-9 and ICD-10 classifications, HIPAA regulations, and CMS guidelines, with a strong focus on promoting integrity and accuracy in medical billing practices. This position offers an excellent opportunity to contribute to the integrity of healthcare documentation and reimbursement processes while supporting organizational compliance initiatives. Position Summary The Certified Professional Coder (CPC) & Coding Compliance Specialist is responsible for ensuring accurate coding, claim submission quality, regulatory compliance, and provider documentation integrity across the organization. This role serves as the primary coding expert for ophthalmology and optometry services, partnering closely with physicians, clinical staff, and the revenue cycle team to improve coding accuracy, reduce denials, optimize reimbursement, and ensure compliance with payer and regulatory requirements. The Coding Compliance Specialist will conduct regular coding audits, provide physician education, review documentation for coding accuracy, assist with claim scrubbing and denial prevention, and identify opportunities to improve charge capture and revenue cycle performance. Essential ResponsibilitiesCoding & Documentation Review

• Review ophthalmology and optometry encounters for coding accuracy and compliance.
• Audit physician documentation to ensure support for billed CPT, HCPCS, and ICD-10 codes.
• Validate modifier usage.
• Review surgical coding for cataract procedures, glaucoma procedures, oculoplastics, retina services, injections, lasers, and office procedures.
• Monitor documentation trends and identify compliance risks. Physician Education & Training
• Serve as the primary coding and documentation resource for physicians and clinical staff.
• Provide one-on-one coaching and education regarding coding changes, payer requirements, and documentation standards.
• Conduct provider coding audits and review findings directly with physicians.
• Develop educational materials and lead training sessions. Revenue Cycle Support
• Review and scrub claims prior to submission.
• Identify coding-related denials and reimbursement risks.
• Collaborate with billers on denial management and appeals.
• Assist with charge capture and revenue leakage identification. Compliance & Auditing
• Perform routine internal coding audits.
• Maintain compliance with CMS, commercial payer, Medicare, and Medicaid guidelines.
• Assist with external audits.
• Monitor regulatory changes and maintain coding policies. Reporting & Quality Improvement
• Track coding audit results and provider performance metrics.
• Monitor denial trends.
• Develop corrective action plans.
• Partner with leadership to improve reimbursement outcomes.

Qualifications Required:

CPC Certification Minimum 5 years medical coding experience Minimum 3 years ophthalmology/optometry coding experience Extensive CPT, HCPCS, ICD-10, and modifier knowledge Provider auditing experience

Preferred:

CPMA Certification Certified Ophthalmic Coding Specialist (COCS) Multi-location practice experience Eyefinity and TriZetto experience Key Performance Indicators (KPIs)

• Coding accuracy rate ≥95%
• Reduction in coding-related denials
• Documentation compliance scores
• Charge capture accuracy
• Reduction in claim rework and resubmissions

Pay:

$20.00

• $30.

00 per hour

Benefits:

401(k) 401(k) matching AD&D insurance Dental insurance Employee discount Flexible spending account Health insurance Health savings account Life insurance Paid time off Professional development assistance Referral program Retirement plan Vision insurance

Work Location:

In person