Senior Coding Compliance Specialist

Job Summary

Seeking a skilled coding professional, the full-time Senior Coding Compliance Specialist will support accurate claims processing by applying regulatory coding guidance, resolving complex claims and appeals, and analyzing billing trends while collaborating across teams to enhance payment integrity and reimbursement accuracy.

Key responsibilities

• Research and validate business decisions and system rationales to support edits, providing education to providers and leadership as needed
• Analyze billing and coding patterns to identify outliers with potentially high-risk practices and resolve appeals by reviewing medical documentation
• Collaborate with multi-disciplinary teams to assure coding compliance and conduct data analysis to support claim edits and denial trends

Required qualifications

• Associate's degree in medical coding with 5+ years of medical coding experience, or high school equivalency with 8+ years of experience
• Completion of a medical coding program and certification in CPC, COC, RHIT, RHIA, CCA, and/or CCS
• Strong knowledge of medical coding, fee and reimbursement mechanisms, and regulatory guidelines including CPT, HCPCS, ICD-10, OPPS, IPPS, and DRGs
• Experience with Epic healthcare software and/or Optum claims edit systems
• Understanding of governmental medical payment policies/regulations and HIPAA regulations