Medical Coding Compliance Specialist - Remote

Job Description

Job Description

Why Professionals Love Theoria Medical

At Theoria Medical, accuracy, integrity, and collaboration matter. Our compliance and coding professionals play a critical role in supporting quality patient care while ensuring our clinical and billing practices remain aligned with evolving industry standards and regulations.

We believe meaningful work should come with flexibility, support, and opportunities for growth. Our teams are empowered with advanced technology, collaborative leadership, and a mission-driven culture that values expertise and innovation.

Build a career where your knowledge drives impact across a growing national healthcare organization.

About Theoria

Theoria Medical is leading the charge in healthcare innovation and quality of care — offering a unique blend of medical excellence and technological advancement, serving the post-acute sector. Our network includes multispecialty physician services covering skilled nursing facilities across the country.

We are currently seeking a Medical Coding Compliance Specialist to support coding accuracy, regulatory compliance, and clinical documentation integrity across the organization.

Competitive Compensation and Benefits Package

We are proud to offer a comprehensive compensation and benefits package designed to support our team members professionally and personally.

Benefits Include:

• Paid Time Off
• 401(k) with employer matching and participation
• Medical, vision, and dental insurance for eligible candidates
• Short and long-term disability insurance for eligible candidates
• Employer-paid life insurance policy
• Technology and tools designed to streamline workflows and improve efficiency

Technology That Makes Work Easier

• Utilize advanced systems and workflows designed to support coding accuracy and compliance
• Access collaborative resources and ongoing regulatory updates
• Work alongside experienced clinical, billing, and revenue cycle teams

What You'll Do

• Conduct Coding Audits
• Perform detailed reviews of medical record documentation and coding to ensure accuracy, completeness, and compliance with ICD-10-CM, CPT, HCPCS, and payer guidelines.
• Identify and Mitigate Risks
• Analyze audit findings to identify compliance trends, risks, and opportunities for improvement.
• Recommend and support corrective action plans.
• Provide Education and Training
• Develop and deliver educational sessions and one-on-one guidance for physicians and staff regarding coding best practices and compliance standards.
• Stay Up to Date on Regulations
• Maintain current knowledge of CMS guidelines, federal and state regulations, and industry coding standards.
• Research and interpret new coding and billing policies.
• Respond to Inquiries
• Serve as a resource for coding, billing, and documentation compliance questions across departments.
• Prepare Reports
• Document audit findings and prepare clear, concise reports for leadership outlining risks and recommendations.
• Investigate Compliance Issues
• Conduct investigations into potential non-compliant activities or billing discrepancies and assist in identifying root causes and solutions.
• Collaborate Across Departments
• Partner closely with billing, revenue cycle management, providers, and operational teams to support compliant and efficient workflows.

Your Qualifications

• Minimum of 5 years of experience in medical coding and auditing.

One or more of the following certifications is required:

• Certified Professional Coder (CPC)
• Certified Coding Specialist (CCS)
• Certified Professional Medical Auditor (CPMA)
• Equivalent industry-recognized certification
• Associate's or Bachelor's degree in Health Information Management or a related field preferred, but not required.
• Experience with Evaluation and Management (E/M) coding, Chronic Care Management (CCM), and Risk Adjustment coding preferred.
• Extensive knowledge of CPT, ICD-10-CM, and HCPCS coding systems.
• Strong understanding of Medicare and Medicaid regulations and compliance standards.
• Strong analytical and problem-solving abilities
• Excellent written, verbal, and presentation communication skills
• High attention to detail and organizational skills
• Ability to maintain confidentiality and professionalism with sensitive patient information

Theoria Medical Invests in You Long-Term

At Theoria Medical, we recognize the importance of compliance professionals in supporting exceptional patient care and operational excellence. We are committed to investing in your growth through ongoing support, collaboration, and career development opportunities.

Connect with a recruiter today to learn more about joining our growing team.

Employee must be able to perform the essential functions of this position satisfactorily, with or without a reasonable accommodation. Theoria Medical conducts criminal background checks and pre-employment drug testing on all candidates upon acceptance of a contingent offer.