Role Description
The Coding Compliance Specialist supports Compliance by conducting audits, investigations, and regulatory response activities related to billing, coding, documentation, privacy, and quality-of-care concerns. This role is responsible for:
• Responding to incidents reported through the compliance hotline
• Performing coding and documentation audits
• Supporting privacy investigations
• Coordinating responses to government payer inquiries
• Identifying compliance risks and ensuring adherence to regulatory requirements
• Supporting corrective action initiatives across the organization
Qualifications
• Strong knowledge of CPT, ICD-10-CM, and HCPCS coding guidelines
• Understanding of federal and state regulations related to billing, coding, and privacy
• Ability to conduct detailed audits and investigations
• Strong analytical skills with the ability to process large data sets
• Excellent written and verbal communication skills
• High attention to detail and organizational skills
• Ability to manage multiple priorities in a fast-paced environment
• Proficiency in Microsoft Word and Microsoft Office Suite
• Ability to work independently and collaboratively across departments
• Maintains strict confidentiality in all aspects of work
Requirements
• Bachelor’s degree in healthcare, business, or related field preferred, or equivalent experience
• Minimum of 3–5 years of experience in coding, auditing, compliance, or related healthcare field
• Required: Active coding certification from AAPC (e.g., CPC or equivalent)
• Preferred: Certification in Healthcare Compliance (CHC) or other HCCA-related certification
Benefits
• Medical insurance, Dental insurance, and Vision insurance
• Health care and dependent care flexible spending account
• 401(k) retirement savings plan with a company match
• Paid time off (PTO) begins accruing immediately upon start date at a rate of 15 days per year
• Ten company-paid holidays per year