Coding Compliance Specialist 1/ Auditor

The Coding Compliance Specialist supports Compliance by conducting audits, investigations, and regulatory response activities related to billing, coding, documentation, privacy, and quality-of-care concerns.

This role is responsible for responding to incidents reported through the compliance hotline, performing coding and documentation audits, supporting privacy investigations, and coordinating responses to government payer inquiries. The position plays a key role in identifying compliance risks, ensuring adherence to regulatory requirements, and supporting corrective action initiatives across the organization.

Review and respond to compliance hotline reports related to billing, coding, documentation, quality of care, and privacy concerns

Conduct investigations and document findings, including root cause analysis and resolution

Collaborate with Compliance, Revenue Cycle Management, Hospital Partners, and reporters.

Escalate high-risk or regulatory issues as appropriate

Perform retrospective and focused audits of medical records to evaluate:

Coding accuracy (CPT, ICD-10-CM, HCPCS)

Documentation completeness and medical necessity

Conduct audits in response to identified risks, hotline complaints, and payer requests

Identify trends and potential areas of non-compliance

Prepare clear, concise audit reports with recommendations

Develop and support the implementation of corrective action plans (CAPs)

Partner with operational and clinical leadership to ensure remediation

Provide education and guidance to providers and staff on coding, documentation, and compliance requirements

Conduct follow-up reviews to assess the effectiveness of corrective actions

Support privacy-related investigations, including potential HIPAA concerns

Assist in documenting findings and mitigation activities

Maintain confidentiality of all protected and sensitive information

Coordinate and prepare documentation submissions (i.e., Attorney General, CMS)

Assist with analysis of payer findings and implementation of required actions

Analyze large data sets to identify trends, anomalies, and risk areas

Maintain audit and investigation tracking logs

Support compliance reporting and program metrics

Collaboration: Demonstrates the ability to work well with others to accomplish a goal and get the work done; takes opinions of others into consideration; includes others in the decision-making process

Drive: Motivated to succeed and get things done at a high level of achievement

Intellectual Curiosity: Demonstrates a genuine interest in learning new things and wants to know the reason “why” behind the way things are done

Commitment: Demonstrates dedication to the job, project, organization, customer/clients and co-workers

Strategic Thinking: Demonstrates the ability to look at the big picture and proactively develop a plan of action

Teamwork: Proactively seek to work with others to accomplish a common goal. Willingness to share challenges and successes with others

Trustworthiness: Demonstrates a high degree of integrity; keeps confidences; does what they say they will do

Bachelor’s degree in healthcare, business, or related field preferred, or equivalent experience

Minimum of 3–5 years of experience in coding, auditing, compliance, or related healthcare field

Required: Active coding certification from AAPC (e.g., CPC or equivalent)

Preferred: Certification in Healthcare Compliance (CHC) or other HCCA-related certification