(Senior) Coding Compliance Specialist

Quartz • Madison, WI

18h • Remote

About The Position

We’re seeking a skilled coding professional to support accurate, compliant, and high-quality claims processing across Quartz. This role may be filled at the Coding Specialist or Senior Coding Specialist level, depending on experience. You’ll play a key role in applying regulatory coding guidance, resolving complex claims and appeals, analyzing billing trends, and collaborating across teams to strengthen payment integrity and reimbursement accuracy. This position offers hands-on work for experienced coders as well as expanded leadership and subject-matter expertise opportunities for senior-level professionals.

Requirements

• High School Equivalency & 1 Year of Relevant Experience
• Completion of a Medical Coding Program
• Certifications in CPC, COC, RHIT, RHIA, CCA, and/or CCS
• Bachelor’s degree with 2 years of relevant experience
• Associate’s degree with 5 years of relevant experience
• High School Equivalency with 8 years of relevant experience
• Completion of a Medical Coding Program
• Certifications in CPC, COC, RHIT, RHIA, CCA, and/or CCS
• Candidates must have access to high-speed, non-satellite Internet to successfully work from home.

Responsibilities

• Review and apply regulatory coding guidelines to ensure accurate and compliant claims processing
• Investigate and resolve coding and claims issues, escalating complex matters as appropriate
• Review, edit, and adjudicate pended or denied claims in HealthLink (Epic) using Claim Edit Software (CES), regulatory guidance, and internal policies
• Research and resolve coding-related appeals by reviewing medical documentation and collaborating with Medical Directors, Pharmacy, and Medical Management
• Analyze billing and coding data to identify trends, outliers, and potential high-risk billing practices
• Conduct data analysis and reporting to support claim edits, denial trends, and leadership insights
• Respond to coding-related inquiries from providers, members, and internal teams through ServiceNow and CRM platforms
• Develop and deliver coding education and training for providers, leadership, and internal teams
• Collaborate with cross-functional teams—including Payment Integrity, Medical Management, SIU, Contracting, Benefits, Customer Success, Marketing, and Provider Reimbursement Configuration—to ensure coding compliance
• Stay current on industry trends, regulatory updates, and coding best practices
• Lead the implementation and oversight of regulatory coding guidelines and complex coding initiatives
• Serve as a subject matter expert (SME) for high-risk or complex coding scenarios
• Research, validate, and optimize claim edit logic, business rules, and system configurations; test outcomes and guide improvements
• Partner with the Special Investigation Unit (SIU) to identify, investigate, and address aberrant billing practices and patterns
• Lead or significantly contribute to coding policy, procedure, and claim edit strategy development
• Drive strategy for coding education, provider communication, and internal training initiatives
• Mentor and support mid-level team members and provide guidance on complex coding decisions

Benefits

• Collaborate with a team that respects and values your coding expertise
• Access professional development opportunities to support your long-term growth
• robust benefits package
• opportunity for career advancement
• professional culture built on the foundations of Respect, Responsibility, Resourcefulness and Relationships

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED