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Healthcare Coding / Medicare Compliance Specialist

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We are looking for an experienced Healthcare Coding and Medicare Compliance Specialist to join our team. This role requires expertise in healthcare coding practices, particularly with ICD-10 and CPT coding, combined with in-depth knowledge of Medicare and Medicare Advantage (MA) programs. The ideal candidate will play a critical role in ensuring accurate coding, optimizing reimbursement processes, and managing Medicare gap closure and compliance with quality measures.

Healthcare Coding:
- Apply correct coding methodologies to clinical documentation to ensure accurate billing and reimbursement.
- Conduct regular audits to verify coding accuracy and compliance with payer guidelines.
- Stay updated with coding guidelines and changes to ensure alignment with industry standards.

Medicare and Medicare Advantage Management:
- Identify and manage Medicare and Medicare Advantage gaps in care, including health risk assessments, preventive services, and chronic care management.
- Collaborate with clinical and administrative teams to address coding discrepancies and ensure complete and accurate documentation.
- Analyze data to track and report Medicare Advantage Star Ratings and other quality performance measures.
- Ensure compliance with CMS regulations, HEDIS measures, and risk adjustment requirements.

Education and Training:
- Provide training to healthcare providers and staff on accurate documentation and coding practices.
- Educate staff on Medicare and Medicare Advantage program requirements and updates.

Quality Assurance:
- Monitor and improve workflows to ensure adherence to regulatory guidelines and optimize reimbursement.
- Implement initiatives to close care gaps, improve patient outcomes, and enhance operational efficiency.

- Certification in medical coding (CPC, CCA, CCS, or equivalent). Bachelor’s degree in healthcare administration, nursing, or a related field preferred.
- Minimum 3–5 years of experience in healthcare coding.
- Proficient understanding of Medicare and Medicare Advantage programs, quality measures, and risk adjustment.
- Strong analytical and problem-solving skills.
- Proficiency in electronic health records (EHR) and coding software.

Certification in Risk Adjustment Coding (CRC) is a plus.

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