Compliance Analyst

Wellpath•Franklin, TN

10d

About The Position

The Compliance Analyst supports the coding compliance and audit program through data collection, analysis, routine coding audits, and report preparation. This role conducts entry- to intermediate-level coding reviews, including services provided in correctional settings and through third-party billing vendors. The position maintains audit documentation, prepares regular compliance reports, and supports efficient audit workflows using available tools. This role also assists senior auditors and leadership with complex audits, regulatory inquiries, and education initiatives.

Requirements

Associate's degree in Health Information Management, Health Sciences, Business, or a related field preferred
Bachelor's degree preferred
Completion of formal coding training program (AAPC, AHIMA, or equivalent) required
Equivalent professional coding credentials and experience may substitute for formal education
Minimum three (3) years of professional medical coding, billing, or coding-audit support experience
Working knowledge of CPT, HCPCS Level II, ICD-10-CM, and modifier guidelines
Experience with EMR systems, encoders, and claims/billing workflows
Familiarity with CMS, OIG, AMA, and payer documentation and coding requirements
Exposure to state Medicaid coding rules, Section 1115 Reentry Demonstration billing requirements, and correctional health workflows required
Certified Professional Coder (CPC) through AAPC — required

Nice To Haves

Experience supporting audits or oversight of third-party billing vendors preferred
Previous correctional/detention facility experience preferred
Certified Professional Medical Auditor (CPMA) through AAPC — preferred, or to be obtained within the first twelve (12) months of employment
Certified Professional Biller (CPB) through AAPC — preferred, given the role's emphasis on third-party billing vendor oversight and government-program payer requirements
Certified Coding Specialist (CCS) through AHIMA may be substituted for an AAPC equivalent

Responsibilities

Conduct routine coding reviews and audits to ensure accurate CPT, HCPCS, ICD-10-CM, and modifier use.
Collect, organize, and validate audit data while maintaining audit workpapers and tracking logs.
Prepare monthly, quarterly, and ad hoc compliance reports and perform data analysis to identify trends and risks.
Support vendor audits and compliance efforts by reviewing documentation, comparing claims, and tracking remediation activities.
Assist with complex audits, regulatory inquiries, education materials, and maintaining audit tools and documentation.