QA Compliance Specialist I, HIM

About Us

Memorial Sloan Kettering Cancer Center (MSK) is united by a singular mission: ending cancer for life. Our specialized care teams provide personalized, compassionate, expert care to patients of all ages. Informed by basic research at our Sloan Kettering Institute, scientists collaborate to conduct innovative translational and clinical research, driving a revolution in understanding and treating cancer. MSK is dedicated to training the next generation of scientists and clinicians, who pursue this mission globally.

About the Role

As a QA Compliance Specialist within Health Information Management (HIM), you’ll ensure the accuracy, integrity, and regulatory compliance of clinical documentation and coding. This role strengthens revenue integrity, audit readiness, and data quality while supporting MSK’s mission to end cancer for life.

Responsibilities

• Perform compliance reviews and formal audits validating ICD-10-CM/PCS, CPT-4, modifiers, Facility Evaluation & Management, and medication administration coding.
• Ensure accurate coding and charge capture aligned with CMS, third-party payer, JCAHO, and HIPAA regulatory standards.
• Identify documentation gaps, trends, and risks impacting coding and billing accuracy, compliance, and audit outcomes.
• Communicate findings and recommendations to HIM leadership, clinical teams, Revenue Integrity, and Patient Accounts partners.
• Coordinate and support external payer audits by preparing documentation and responding to data requests.
• Participate in special projects focused on data management, quality improvement, and process optimization.
• Maintain audit documentation, tracking tools, and reporting to support continuous compliance monitoring.
• Apply independent judgment while operating within defined objectives and regulatory frameworks.
• Promote corrective actions and process enhancements to strengthen coding quality and operational consistency.
• Review and track denials to ensure coding accuracy based on documentation and compliance with regulatory policies and standards.

Qualifications

• Minimum of 3 years of experience in medical terminology, anatomy and physiology, hospital coding and billing, and medical records.
• Demonstrated expertise with ICD-10-CM/PCS, CPT, and Facility Evaluation & Management coding.
• Hands-on experience conducting coding audits, compliance reviews, and regulatory validation activities.
• Working knowledge of healthcare regulatory requirements, including CMS guidelines and HIPAA standards.
• Proficiency using PC applications such as Microsoft Excel and Word for reporting, analysis, and documentation.

Skills

• Strong analytical and problem-solving abilities to identify trends, risks, and improvement opportunities in complex data sets.
• Clear, confident communication skills to present findings, provide guidance, and collaborate across multidisciplinary teams.
• High attention to detail and organizational discipline to manage large volumes of sensitive and complex information accurately.
• Ability to navigate multiple clinical, billing, and data systems while adapting to evolving workflows and regulations.

Schedule

Monday – Friday, 9 am – 5 pm (flexibility to start as early as 6:30 am). Hybrid role; on-site at 633 Third Avenue in NYC 4 times a year.

Pay

Pay Range: $69,400.00 - $107,600.00. FLSA Status: Exempt.

Benefits

MSK believes in fair, competitive pay that reflects your job, experience, and skills. MSK is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment.