Senior Coding Compliance Specialist

Quartz is seeking a skilled coding professional to support accurate, compliant, and high-quality claims processing as a Senior Coding Compliance Specialist. This position will apply regulatory coding guidance, resolving complex claims and appeals, analyzing billing trends, and collaborating across teams to strengthen payment integrity and reimbursement accuracy. The Senior Coding Compliance Specialist will investigate, implement, and audit the outcomes of coding and regulatory guidelines. This position will serve as a subject matter expert for coding inquiries from internal and external customers.

Responsibilities

• Research and validate business decisions and system rationales to support edits and conduct testing to validate outcomes.
• Provide education as appropriate to providers and leadership.
• Analyze billing and coding patterns and identify outliers with potentially high-risk practices.
• Review and resolve appeals in system(s) by reviewing medical documentation and making determination.
• Work with Clinical Services teams as needed to resolve appeal cases.
• Research and respond to customer inquiries and tickets routed for coding expertise.
• Review, edit, and adjudicate claims that are pended and/or assigned in systems.
• Collaborate across multi-disciplinary teams to assure coding compliance.
• Conduct data analysis and reporting to support claim edits, denial trends, and leadership insights.

Qualifications

• Associate's degree in medical coding with 5+ years of medical coding experience OR high school equivalency with 8+ years of medical coding experience
• Completion of medical coding program
• Certification in CPC, COC, RHIT, RHIA, CCA, and/or CCS
• Strong working knowledge of medical coding, fee and reimbursement mechanisms
• Strong understanding of medical coding and regulatory guidelines, which include CPT, HCPCS, ICD-10, OPPS, IPPS, DRGs
• Epic healthcare software and/or Optum claims edit system knowledge
• Strong understanding of governmental medical payment policies/regulations and their updates processes
• Knowledge of HIPAA regulations
• Strong analytical and problem-solving skills using critical thinking
• Strong verbal and written communication skills
• Intermediate level of proficiency with Microsoft Office
• Ability to multi-task, prioritize, and manage time wisely
• Self-motivated, ability to work independently to successfully investigate complex issues
• Hardware and equipment will be provided by the company, but candidates must have access to high-speed, non-satellite Internet to successfully work from home.

Benefits

• Collaborate with a team that respects and values your coding expertise
• Access professional development opportunities to support your long-term career growth
• Starting salary based upon skills and experience: $56,600 - $70,600 plus robust benefits package
• Excellent benefit and compensation package, opportunity for career advancement and a professional culture built on the foundations of Respect, Responsibility, Resourcefulness and Relationships