Behavioral Health Medical Coding & Compliance Specialist

About this Role: 

The Behavioral Health medical Coding & Compliance Specialist (“Behavioral Health medical Coding & Compliance Specialist”) is an integral member of Community Reach Center’s Quality Improvement (“QI”) Division. The Behavioral Health medical Coding & Compliance Specialist is responsible for managing all aspects of assigned projects, reviewing compliance standards to maintain quality assurance functions, and support risk management activities for the agency. Additionally, the Behavioral Health medical Coding & Compliance Specialist will have other duties and responsibilities as determined from time to time by the Utilization Manager.

Essential Functions: 

• Designs and implements internal compliance audits, regularly monitoring accuracy and adherence to documentation requirements in collaboration with Utilization Manager to support continuous quality improvement and compliance as identified in the Quality Management Plan (QMP).
• Conducts audits as determined by the Manager or Director.
• Oversees preparation and participates in response to external audits to ensure appropriate access to authorized protected health information (PHI) and coordinating with Program Managers and other Managers and Directors to address and monitor corrective action needs.
• Collaborates with Utilization Manager and QI Manager to implement, track, and monitor client outcomes to identify opportunities for continuous quality improvement.
• Maintains knowledge of current Colorado State laws, rules, and policies around mental health licensure and a working knowledge of current clinical practices.
• Maintains knowledge of and certifications for Certified Professional Coder (CPC) or Certified Coding Specialist Physician Based (CCSP).
• Creates, communicates and implements templates, systems and processes to ensure clinical documentation at the Center is in accordance with internal policies and procedures, Centers for Medicare and Medicaid Services (CMS), State and Federal regulations, third-party payors, and American Medical Association (AMA) guidelines.

Core Competencies:

• Flexibility and Adaptability: Demonstrates the ability to adjust to changing circumstances, priorities and new challenges while remaining effective and productive. Has a willingness to learn new skills and technologies. Can handle shifts in work arrangements, evolving company strategies, and unexpected problems with a positive attitude.
• Reliability and Commitment: Demonstrates consistency and follow-through on assignments, meeting deadlines, and quality of work. Arrives on time, is prepared for meetings, communicates issues promptly, and takes responsibility for their actions by admitting and correcting mistakes. Shows commitment by being present, engaged and consistently putting forth their best effort to achieve goals.
• Communication: Demonstrates the ability to convey and receive information clearly, concisely, and in the appropriate context. Has the knowledge and skills to convey information accurately, effectively, and appropriately in various professional situations.
• Learning and Self-Development: Proactively improving one’s knowledge and skills by continuously learning, understanding personal strengths and weaknesses, identifying areas for growth, seeking feedback, and building professional relationships.
• Performance and KPI Alignment: Demonstrates accountability for role expectations by understanding and consistently working toward key performance indicators (KPIs) that have been provided by their manager and/or Human Resources. Uses KPIs to prioritize daily work, track progress, and measure outcomes over time (e.g., productivity, quality, timeliness, attendance, customer/service expectations, or other role-specific targets). Communicates proactively about barriers that may impact KPI performance, seeks clarification when expectations are unclear, and partners with leadership to develop action steps that support improvement and sustained results.
• Code of Conduct and Employee Handbook Compliance and policy and procedures (Emotional Intelligence): Demonstrates professionalism and integrity by understanding and consistently adhering to the organization’s Code of Conduct and Employee Handbook expectations. Follows workplace policies and procedures (e.g., confidentiality, respectful workplace standards, safety requirements, timekeeping, appropriate use of technology, and ethical decision-making). Seeks guidance when unsure about a policy, completes required training as assigned, and promptly reports concerns through appropriate channels. Represents the organization appropriately in interactions with coworkers, clients/customers, and community partners, maintaining conduct that supports a safe, respectful, and accountable workplace culture. The ability to self0regulate and recognize the effects of your behavior on others.

Qualifications:

• Bachelors degree preferred - will consider applications with no Bachelors IF candidate has CPC and minimum 5 years experience in a like role
• Two years minimum experience healthcare auditing or utilization review
• Certified Professional Coder, required.
• CPMA, CPS or CDEO certifications are a plus
• Strong professional knowledge of Microsoft Office Suite of Products, including PowerPoint.
• Communication, organization, time management and clinical skills.
• Bilingual Spanish a plus
• Chart Review experience, behavior health chart review experience preferred

Schedule: 

M-F 8-5, flexible remote working conditions will be considered. 

Salary Information:

$65,000-$75,000/yr

Accepting applications on an on-going basis