Coding Compliance Specialist

Role Description: Coding Compliance Specialist is a full-time, in-person role based in Bronx, NY. This role is responsible for coding compliance, physician education, internal and external audits, ensure accuracy, regulatory compliance, and alignment with payer requirements. Day-to-day tasks include conducting internal audits, identifying coding risks, recommending corrective actions, and supporting providers and staff with education on coding standards and documentation best practices. The specialist will collaborate with revenue cycle, billing, and clinical teams to prevent denials, reduce compliance exposure, and improve coding processes. The role also involves monitoring regulatory changes, updating policies and procedures, and preparing reports that highlight trends, findings, and opportunities for improvement.

Qualifications: Demonstrated skills in Compliance Management with the ability to interpret and apply healthcare regulations and organizational policies. Strong Regulatory Compliance knowledge, including familiarity with payer guidelines, coding standards (ICD, CPT, HCPCS), and documentation requirements. Advanced Analytical Skills to review data, identify patterns, assess risk, and develop recommendations that support accurate coding and reduced denials. Effective Communication skills to explain complex compliance concepts clearly, collaborate with multidisciplinary teams, and provide training and guidance to staff and providers. Relevant certification such as CPC, CCS, or equivalent coding credential preferred; experience in medical coding, billing, or revenue cycle in a healthcare setting is highly beneficial. Proficiency with electronic health records and coding/billing software; strong attention to detail and a commitment to ethical, compliant practices. Ability to manage time effectively, and adapt to changing regulatory and payer requirements.