5 Medical Coding Certifications You Didn’t Know About

You’d be surprised how many people outside of the world of medical coding aren’t aware of all the different types of medical coding certifications that can be obtained. Contrary to popular belief, it’s not just medical coding and medical billing. There are options for every specialty and role within medical coding.

Let’s go over five in particular that you might not know about.

1. CPMA® (Medical Auditor)

The Medical Coding Auditor employed at the Physician’s office or Health Plan level understands the organizational strategy and operational objectives of the entity. Following established guidelines and procedures, a medical coding auditor will check medical coding and billing information for efficiency, accuracy and compliance prior to submitting claims in order to prevent audit findings from external audits. The Professional Medical Coding Auditor provides the physicians with specific education based on their quality monitoring of claim denials and healthcare trends.

2. COC® (Hospital Outpatient)

The Outpatient Facility Coder employed at the Emergency Room, Ambulatory Surgical Center and Outpatient Wing of the Hospital understands the intricacies of the operative report at an advanced level. This professional will know the facility coding guidelines and have an avid knowledge of strong modifier usage. The COC® will code all facility outpatient diagnoses and procedural occurrences, through the review of clinical documentation and diagnostic results. The COC® will accurately abstract data into the electronic medical record systems, verifying accurate patient dispositions and physician data, following the Official ICD-CM Guidelines for Coding and Reporting and CPT Guidelines.

3. CPPM® (Coding Manager)

The Certified Professional Practice Manager oversees and coordinates all departments of the entity by using their extensive knowledge in operations relating to accreditations, financial management, quality assurance, compliance, human resources, revenue cycle, clinical quality and workflow optimization.  The CPPM® relies heavily on their integrity and sound judgment in order to ensure efficiency and growth.   This professional establishes and maintains effective quality control standards in order to deliver high quality patient care and grow the entity.   The person in this key leadership role will provide the fundamental personal and professional growth mentorship to staff in order to foster environments of openness, trust and highly effective teamwork. 

4. CRC® (Risk Adjuster)

he Certified Risk Coder typically works remotely and is employed at Health Plans and Physician Network settings. The CRC® understands the high importance of reporting chronic diagnosis at an advanced level.  The CRC® professional is an invaluable resource in the process capturing ICD-CM codes that map to HCCs, RxHCCs and many other models.  This professional will perform retroactive and prospective reviews on medical records in order to identify, assess, monitor and capture all clinically appropriate risk adjusting conditions for quality metrics.

5. CPCO® (Compliance Officer)

The Certified Professional Compliance Officer oversees, coordinates and ensures all the elements of the Corporate Compliance Programs are followed and maintained effectively. With their extensive knowledge of healthcare administration and knowledge of applicable compliance policies, this professional will often coordinate, develop and maintain policies for the entity.  The CPCO® professional will also have an extensive knowledge of laws, and regulations in order to collaborate with the workflow of the certified professional medical auditors. Additionally, this professional understands the high importance of tracking and logging of scores in order to organize detailed sensitive data mining related to compliance initiatives.

Be sure to check out our courses page for info on all of the certification courses we offer!