Coding Compliance Specialist
1 month ago
Tacoma
Job Description About Sound Founded in 2001 and headquartered in Nashville, TN, Sound Physicians is a nationally respected, physician-led medical group practicing in 400+ hospitals across 45 states. Our team of 4,000+ clinicians and 1,000+ business professionals across the country is united by one mission: to build exceptional clinical partnerships that unlock quality, affordable, dignified care for everyone – no matter who they are or where they live. With physician-led clinical teams and more than two decades of operational expertise, we’ve refined what it takes to consistently deliver exceptional care in hospital medicine, emergency medicine, critical care, anesthesia, and telemedicine. Why join us? • A remote-first culture that values flexibility and collaboration, • Opportunities to grow your career while making a real impact Sound Physicians offers a competitive benefits package inclusive of the items below, and more: • Medical insurance, Dental insurance, and 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 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. Essential Duties and Responsibilities Compliance Investigations & Hotline Response: • 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 Audit & Monitoring: • 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 Corrective Action & Education: • 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 Privacy & Compliance Support: • Support privacy-related investigations, including potential HIPAA concerns, • Assist in documenting findings and mitigation activities, • Maintain confidentiality of all protected and sensitive information Government & Payer Response: • Coordinate and prepare documentation submissions (i.e., Attorney General, CMS), • Assist with analysis of payer findings and implementation of required actions Data Analysis & Reporting: • Analyze large data sets to identify trends, anomalies, and risk areas, • Maintain audit and investigation tracking logs, • Support compliance reporting and program metrics Values • Drive: Motivated to succeed and get things done at a high level of achievement, • Intellectual Curiosity: Demonstrates a genuine interest in learning new things and wants to know the reason “why” behind the way things are done, • Collaboration: Demonstrates the ability to work well with others to accomplish a goal and get the work done; takes opinions of others into consideration; includes others in the decision-making process, • Commitment: Demonstrates dedication to the job, project, organization, customer/clients and co-workers, • Strategic Thinking: Demonstrates the ability to look at the big picture and proactively develop a plan of action, • Teamwork: Proactively seek to work with others to accomplish a common goal. Willingness to share challenges and successes with others, • Trustworthiness: Demonstrates a high degree of integrity; keeps confidences; does what they say they will do Knowledge, Skills, and Abilities • 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, • Ability to work independently and collaboratively across departments, • May require interaction with clinical staff, leadership, and external stakeholders, • Maintains strict confidentiality in all aspects of work Education & Experience • 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, • Required: Active coding certification from AAPC (e.g., CPC or equivalent), • Preferred: Certification in Healthcare Compliance (CHC) or other HCCA-related certification Salary Range • $55,000 - $75,000 annually. Exact pay will be determined based on candidate experience, geographical location, and size/complexity of the program being supported. Sound Physicians is an Equal Employment Opportunity (EEO) employer and is committed to diversity, equity, and inclusion at the bedside and in our workforce. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, gender identity, sexual orientation, age, marital status, veteran status, disability status, or any other characteristic protected by federal, state, or local laws. This job description reflects the present requirements of the position. As duties and responsibilities change and develop, the job description will be reviewed and subject to amendment. #Soundbc