Healthcare Coding Compliance Specialist

2 weeks ago


Baltimore Maryland, United States University of Maryland Medical System Full time
Job Overview

I. General Summary


The role involves conducting thorough audits of hospital inpatient, ambulatory surgery, observation, and various outpatient encounters to ensure appropriate reimbursement, compliance with federal and state regulations, and adherence to established coding classification systems such as ICD-10-CM/PCS and CPT-4.

II. Key Responsibilities


The following responsibilities outline the primary functions of this position. They are not intended to be an exhaustive list of all duties performed by individuals in this role.

  • Act as a clinical coding expert, employing critical thinking skills to assess and resolve documentation issues in collaboration with medical staff and clinical documentation specialists as necessary.
  • Conduct audits of ICD-10 diagnostic codes and CPT-4 procedure codes related to outpatient, ambulatory surgery, and observation visits, ensuring compliance with relevant regulations.
  • Evaluate complex inpatient cases, including trauma, rehabilitation, neurology, and critical care, utilizing ICD-10-CM and ICD-10-PCS coding systems to guarantee accurate assignment of APR-DRG/SOI/ROM and POA.


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