Compliance Analyst (Remote)

Key Responsibilities

• Conduct routine coding reviews and audits to ensure accurate CPT, HCPCS, ICD-10-CM, and modifier use.
• Collect, organize, and validate audit data while maintaining audit workpapers and tracking logs.
• Prepare monthly, quarterly, and ad hoc compliance reports and perform data analysis to identify trends and risks.
• Support vendor audits and compliance efforts by reviewing documentation, comparing claims, and tracking remediation activities.
• Assist with complex audits, regulatory inquiries, education materials, and maintaining audit tools and documentation.

Qualifications & Requirements

• Education: Associate's degree in Health Information Management, Health Sciences, Business, or a related field preferred; Bachelor's degree preferred.
• Completion of formal coding training program (AAPC, AHIMA, or equivalent) required.
• Equivalent professional coding credentials and experience may substitute for formal education.
• Experience: Minimum three (3) years of professional medical coding, billing, or coding-audit support experience.
• Working knowledge of CPT, HCPCS Level II, ICD-10-CM, and modifier guidelines.
• Experience with EMR systems, encoders, and claims/billing workflows.
• Familiarity with CMS, OIG, AMA, and payer documentation and coding requirements.
• Exposure to state Medicaid coding rules, Section 1115 Reentry Demonstration billing requirements, and correctional health workflows required.
• Experience supporting audits or oversight of third-party billing vendors preferred.
• Previous correctional/detention facility experience preferred.