Compliance Analyst

Job Description

Job Description

Overview

The Compliance Analyst supports the coding compliance and audit program through data collection, analysis, routine coding audits, and report preparation. This role conducts entry- to intermediate-level coding reviews, including services provided in correctional settings and through third-party billing vendors. The position maintains audit documentation, prepares regular compliance reports, and supports efficient audit workflows using available tools. This role also assists senior auditors and leadership with complex audits, regulatory inquiries, and education initiatives.

Responsibilities

• Conduct routine coding reviews and audits to ensure accurate CPT, HCPCS, ICD-10-CM, and modifier use.
• Collect, organize, and validate audit data while maintaining audit workpapers and tracking logs.
• Prepare monthly, quarterly, and ad hoc compliance reports and perform data analysis to identify trends and risks.
• Support vendor audits and compliance efforts by reviewing documentation, comparing claims, and tracking remediation activities.
• Assist with complex audits, regulatory inquiries, education materials, and maintaining audit tools and documentation.

Qualifications

Education

• Associate's degree in Health Information Management, Health Sciences, Business, or a related field preferred
• Bachelor's degree preferred
• Completion of formal coding training program (AAPC, AHIMA, or equivalent) required
• Equivalent professional coding credentials and experience may substitute for formal education

Experience

• Minimum three (3) years of professional medical coding, billing, or coding-audit support experience
• Working knowledge of CPT, HCPCS Level II, ICD-10-CM, and modifier guidelines
• Experience with EMR systems, encoders, and claims/billing workflows
• Familiarity with CMS, OIG, AMA, and payer documentation and coding requirements
• Exposure to state Medicaid coding rules, Section 1115 Reentry Demonstration billing requirements, and correctional health workflows required
• Experience supporting audits or oversight of third-party billing vendors preferred
• Previous correctional/detention facility experience preferred

Licenses/Certifications

• Certified Professional Coder (CPC) through AAPC — required
• Certified Professional Medical Auditor (CPMA) through AAPC — preferred, or to be obtained within the first twelve (12) months of employment
• Certified Professional Biller (CPB) through AAPC — preferred, given the role's emphasis on third-party billing vendor oversight and government-program payer requirements
• Certified Coding Specialist (CCS) through AHIMA may be substituted for an AAPC equivalent