Compliance Analyst (Seeking candidates located in Tennessee) at Wellpath

Franklin, Tennessee, United States -

Full Time

Start Date

Immediate

Expiry Date

18 Sep, 26

Salary

0.0

Posted On

20 Jun, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Medical Coding, Coding Audits, Data Analysis, CPT, HCPCS, ICD-10-CM, Modifier Guidelines, EMR Systems, Claims Workflow, Billing Oversight, Regulatory Compliance, Report Preparation, Correctional Health Workflows, Medicaid Coding, Audit Documentation, Vendor Management

Industry

Hospitals and Health Care

Description

You Matter • Make a difference every day in the lives of the underserved• Join a mission driven organization with a people first culture• Excellent career growth opportunities Join us and find a career that supports:• Caring for overlooked, underserved, and vulnerable patients• Diversity, equity, inclusion, and belonging• Autonomy in a warm team environment• Growth and training Perks and Benefits In addition to comprehensive benefits including medical, dental, vision, paid time off, and 401k, we foster a work, life balance for team members and their family to support physical, mental, and financial wellbeing including: • DailyPay, receive your money as you earn it! • Tuition Assistance and dependent Scholarships• Employee Assistance Program (EAP) including free counseling and health coaching• Company paid life insurance• Tax free Health Spending Accounts (HSA)• Wellness program featuring fitness memberships and product discounts• Preferred banking partnership and discounted rates for home and auto loans *Eligibility for perks and benefits varies based on employee type and length of service. Why Us Now is your moment to make a difference in the lives of the underserved. If there is one unifying characteristic of everyone on our team, it is the deep desire to make a difference by helping society's most vulnerable and often overlooked individuals. Every day we have the distinct honor and responsibility to show up with non-judgmental compassion to provide hope and healing to those who need it most. For those whose calling it is to serve others, now is your moment to join our mission to provide quality care to every patient with compassion, collaboration, and innovation, to live our mantra to “Always Do The Right Thing!”, and to collectively do our part to heal the world, one patient at a time. Wellpath sees hundreds of thousands of unique individuals in their facilities month over month and a very large percent of those individuals receive direct clinical care, which includes lives saved by Narcan. We offer ongoing training and development opportunities for licensed and unlicensed healthcare team members, and have best in class clinical resources for training, education, and point of care support. How you make a difference 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. Key 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. Additional Details Seeking candidates in located in Tennessee. Qualifications & Requirements Education 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 Experience 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 Experience supporting audits or oversight of third-party billing vendors preferred Previous correctional/detention facility experience preferred Licenses/Certifications Certified Professional Coder (CPC) through AAPC — required 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 We are an Equal Employment Opportunity Employer We are committed to fostering, cultivating, and preserving a culture of uniqueness. We celebrate a variety of backgrounds and are committed to creating an inclusive environment for all employees. We encourage you to apply! If you are excited about a role but your experience doesn’t seem to align perfectly with every element of the job description, we encourage you to apply. You may be just the right candidate for this, or one of our many other roles. Deadline to apply to this position is contingent upon applicant volume. Those positions located in Colorado will have a specific deadline posted in the job description. We are an Affirmative Action Employer in accordance with applicable state and local laws.

Responsibilities

The Compliance Analyst performs routine coding reviews and audits to ensure accurate use of CPT, HCPCS, and ICD-10-CM codes. They are responsible for collecting audit data, preparing compliance reports, and supporting the oversight of third-party billing vendors.