Integrity and Compliance Coding Analyst

About the role

This position conducts documentation, coding, and billing reviews to identify, reduce, and mitigate compliance-related risk. The role evaluates medical record documentation, coding accuracy, and billing practices to ensure adherence to regulatory requirements, payer policies, and organizational standards. The Integrity and Compliance Coding Analyst collaborates closely with operational and clinical partners to communicate findings, recommend corrective actions, and support ongoing compliance and revenue integrity efforts.

Responsibilities

• Conduct medical documentation, coding, and billing reviews to identify compliance concerns and areas of potential risk.
• Analyze review findings, investigate billing issues, and prepare clear summaries and reports.
• Develop, support, and monitor corrective action plans to address identified deficiencies and improve compliance outcomes.
• Ensure effective communication and handoff of review results, recommendations, and remediation activities.
• Apply knowledge of ICD-10-CM, CPT, HCPCS, Medicare, Medicaid, commercial payer requirements, and healthcare billing regulations.
• Stay current on documentation, coding, billing, and regulatory changes impacting healthcare organizations.
• Evaluate the quality, accuracy, and consistency of review findings.
• Partner with clinical providers, revenue cycle teams, health information teams, and other operational teams.
• Present findings and recommendations to leadership and support education related to documentation, coding, and billing compliance.
• Foster a culture of compliance through collaboration, consultation, and problem-solving.
• Identify opportunities to improve audit methodologies, monitoring activities, and reporting processes.
• Recommend innovative approaches to strengthen compliance monitoring and risk mitigation programs.

Requirements

• Certified coder (CPC, CCS, RHIT, RHIA, CPMA, or equivalent) with five or more years of relevant experience, and/or a bachelor's degree in a related field.
• Demonstrated experience conducting documentation reviews, coding audits, billing investigations, and compliance assessments.
• Strong understanding of medical terminology, anatomy and physiology, disease processes, clinical documentation, and healthcare reimbursement.

Skills

• Strong analytical, investigative, and problem-solving abilities.
• Excellent written and verbal communication skills.
• Ability to manage multiple priorities and communicate effectively with leaders and stakeholders across the organization.