Coding and Compliance Specialist

Medical Coding and Compliance Specialist - CPC

Join to apply for the Medical Coding and Compliance Specialist - CPC role at Concentra

Concentra is recognized as the nation’s leading occupational health care company. With more than 40 years of experience, Concentra is dedicated to improving the health of America’s workforce.

The Coding and Compliance Specialists for Occupational Medicine and Specialty perform detailed coding and documentation audits to ensure compliance with clinical and coding guidelines. This function is critical to the overall revenue cycle in supporting charge entry, level of service selection, procedure and diagnosis coding, as well as one‑on‑one and group education and training to employed and contracted clinicians.

• Perform compliance audits for designated clinicians/centers consistent with established audit protocols and nationally recognized guidelines.
• Meet the production and QA standards as set out in Concentra Coding and Compliance policies.
• Analyze audit findings and identify/assess potential compliance risks related to coding and billing and notify clinical leadership regarding outliers.
• Organize and present audit findings to each clinician as indicated by audit results, denial and downcoding trends, and/or as requested by medical leadership, center leadership or central billing office leadership.
• Schedule meetings to present audit findings and be available to meet with clinicians via Zoom as their schedules dictate, accommodating calls outside normal working hours when the need arises.
• Assist CBOs with reconsideration, appeals process and coding support as requested.
• Participate in special projects and collaborate with other departments to support coding, auditing and compliance initiatives.
• Provide clinician support, education and training related to the quality of documentation, level of service, procedure and diagnosis coding consistent with established coding guidelines and standards.
• Assist Medical Leadership in development of clinician training plans and for active support in the training process under guidance of coding leadership.
• Monitor coding and state workers’ compensation changes to ensure that most current information is available.
• Ensure adherence to all state and federal guidelines applicable to coding, billing and documentation compliance for workers’ compensation in all served markets.

Education Level: High School Diploma or GED equivalent

• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS).
• Must maintain a coding credential from AAPC or AHIMA organization.
• Must complete CEUs to maintain this credential bi‑annually or as required by the organization.
• Must maintain membership to the AAPC or AHIMA organization.

• Customarily has at least three (3) years of experience working as a certified Coder.
• Prefer at least 2 years in coding and compliance/clinical audit field.
• Prefer experience in dealing directly with, and in presenting work product to clinicians.

• 401(k) Retirement Plan with Employer Match.
• Medical, Vision, Prescription, Telehealth, & Dental Plans.
• Life & Disability Insurance.
• Paid Time Off.
• Colleague Referral Bonus Program.
• Tuition Reimbursement.
• Commuter Benefits.
• Dependent Care Spending Account.
• Employee Discounts.

We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation if required.

* This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management*

Concentra is an Equal Opportunity Employer, including disability/veterans. Concentra provides equal employment and affirmative action opportunities to applicants and employees without regard to race, color, age, religion, sex, sexual orientation, gender identity, national origin, pregnancy, protected veteran status, disability, or other protected categories. In addition, Concentra Inc. complies with applicable state and local laws prohibiting discrimination in employment in every jurisdiction in which it maintains facilities.

Mid‑Senior level

Full‑time

Health Care Provider

Hospitals and Health Care