Sound Physicians

Coding Compliance Specialist

Sound Physicians

full-time

Posted on:

Location Type: Remote

Location: Washington • United States

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Salary

💰 $55,000 - $75,000 per year

About the role

  • 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
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
codingauditingcomplianceCPT codingICD-10-CM codingHCPCS codingroot cause analysisdata analysiscorrective action plansdocumentation
Soft Skills
analytical skillscommunication skillsattention to detailorganizational skillsability to manage multiple prioritiescollaborationproblem-solvingconfidentialityeducation and guidancereport writing
Certifications
CPCCHCAAPC certificationHCCA-related certification