Senior Billing & Coding Compliance Consultant

• Serve as a billing integrity project leader for all service lines, developing and conducting individual or group presentations on coding, billing, and compliance topics
• Develop and deliver standardized and specialty-driven coding and compliance training (“onboarding”) for new providers
• Perform post-onboarding pre-bill reviews of professional charges for any service line
• Assist in ensuring pending charges are reviewed and released in a timely manner
• Independently review the adequacy of medical record documentation to support procedure, modifier, and diagnosis coding, identify compliance risks, and develop recommended solutions or action plans
• Summarize findings and develop action plans for risk mitigation
• Research and respond to coding, documentation, and reimbursement policy questions or problems
• Support and/or conduct risk-based billing compliance audits and provide resulting education in coordination with the Compliance Office
• Complete charge review and follow-up Epic work queue assignments for any service line
• Provide training to new internal or contractor staff on audit software, Epic, audit plans, and work queue assignments
• Develop and implement quality improvement or corrective action plans
• Perform other duties as assigned to support billing and coding compliance initiatives

• High School Diploma or equivalent and six (6) years of experience in a professional billing environment with emphasis on coding, auditing, and/or compliance responsibilities
• Certification as Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Medical Coder (CMC) required
• Must obtain Certified Professional Medical Auditor (CPMA) certification within 12 months of hire
• Strong knowledge of CPT, HCPCS, and ICD-9-CM coding systems, medical record documentation standards, and accepted billing/coding standards
• Ability to analyze medical records, billing history, payer rules, and other data to validate regulatory compliance and organizational billing integrity
• Experience developing and conducting coding and compliance training and presentations for individuals and groups
• Strong verbal and written communication skills
• Ability to work independently and collaboratively as a team member
• Proficiency in Microsoft Office (Word, Excel, PowerPoint)
• Detail-oriented with strong organizational and prioritization skills
• Flexibility to adapt to new processes and procedures

Bachelor’s Degree or Registered Nurse credential desired

• Competitive medical, dental, vision, Health Savings Account, Dependent Care FSA, and supplemental coverage
• 401k plan with company match
• Paid time off, sick time, and paid company holidays
• Employee Assistance Program (EAP) providing services like virtual counseling, financial services, legal services, life coaching