Coding Compliance Specialist

Role Overview

• 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

Requirements

• 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
• Active coding certification from AAPC (e.g., CPC or equivalent) required
• Certification in Healthcare Compliance (CHC) or other HCCA-related certification preferred
• Strong knowledge of CPT, ICD-10-CM, and HCPCS coding guidelines
• Understanding of federal and state regulations related to billing, coding, and privacy
• Ability to conduct detailed audits and investigations
• Strong analytical skills with the ability to process large data sets
• Excellent written and verbal communication skills
• High attention to detail and organizational skills
• Ability to manage multiple priorities in a fast-paced environment
• Proficiency in Microsoft Word and Microsoft Office Suite

Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• Health care and dependent care flexible spending account
• 401(k) retirement savings plan with a company match
• Paid time off (PTO) begins accruing immediately upon start date at a rate of 15 days per year, in accordance with Sound's PTO policy
• Ten company-paid holidays per year