Compliance Analyst (Remote)

Wellpath; Franklin (TN); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Medical, dental, vision

401k

Paid time off

Wellness program

Job summary

Wellpath seeks a Compliance Analyst to support coding compliance and audit programs in correctional health settings. You will perform entry- to intermediate-level coding reviews, focusing on CPT, HCPCS, ICD-10-CM, and modifiers, and help maintain audit documentation.

Responsibilities include data collection, monthly/quarterly reports, and collaboration with senior auditors. Ideal candidates have formal coding training (AAPC/AHIMA) and knowledge of Medicaid requirements.

Qualifications

• Formal coding training completed (AAPC/AHIMA).
• Experience with CPT, HCPCS Level II, ICD-10-CM and modifiers.
• Knowledge of Medicaid rules and regulatory guidelines.

Responsibilities

• Conduct routine coding reviews and audits for CPT/HCPCS/ICD-10-CM and modifiers.
• Collect, organize, and validate audit data and maintain workpapers.
• Prepare regular compliance reports and perform data analysis to identify risks.
• Assist vendor audits and educate stakeholders on findings and remediation.

Skills

CPT/HCPCS/ICD-10-CM knowledge

Data analysis

Coding audits

Education

Associate's degree in Health Information Management

Bachelor's degree preferred

Formal coding training program (AAPC/AHIMA)

Tools

EMR systems

Encoders

Claims/billing workflows

Job description

• 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

• 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
• 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

Why Us

Now is your moment to make a difference in the lives of the underserved.

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

Ideal candidate will have completed a formal coding training program (AAPC, AHIMA, or equivalent) and be familiar with Medicaid and regulatory guidelines.

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 value the contributions of team members with a broad range of experiences, skills, and perspectives and are committed to providing equal employment opportunity for all.

This position is available only to those who reside in the United States.

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.