COMPLIANCE SPECIALIST-Inpatient

Duke PF; Durham (NC); On-site; USD 75,000 - 95,000; Full time

Benefits offered by this job

Sign-on bonus $10,000

Remote work

Job summary

Duke Health is seeking a compliance professional to implement and maintain programs aligned with the Office of Inspector General work plan. The role emphasizes education, internal audits, and collaboration with clinical staff to reduce legal and financial risk.

Responsibilities include educating providers on regulations, performing routine audits, and coordinating with payers. A Bachelor’s degree and relevant coding/auditing experience are required, with professional certifications preferred.

Qualifications

• 4 years of admin experience in compliance, coding and auditing.
• Two years must involve DRGs and APR‑DRGs.
• RHIA or RHIT or CCS or CPC or CPMA certifications preferred.

Responsibilities

• Educate providers on compliance with regulations (Medicare/Medicaid, HIPAA).
• Analyze current situations and set priorities for clinic needs.
• Identify coding and billing risk areas and implement corrective actions.
• Conduct routine internal audits of provider documentation.
• Collaborate with physicians and staff to improve documentation and compliance.
• Review controls, policies, procedures for compliance with guidelines and sound practices.
• Respond to concerns and implement corrective actions.
• Communicate with Medicare/Medicaid carriers and payers.
• Promote compliance initiatives with faculty and administration.
• Perform other related duties.

Skills

Medicare guidelines

Coding & billing

Audit processes

Communication with payers

Compliance education

Education

Bachelor's degree

Job description

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.

This position is 100% remote. All Duke University remote workers must reside in one of the following states:

• North Carolina, Alabama, Arizona, Connecticut, District of Columbia, Florida, Georgia, Illinois, Iowa, Kentucky, Louisiana, Maine, Michigan, Missouri, Montana, New Hampshire, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Washington.

*Now offering a $10,000 sign‑on bonus that will pay out in 4 equal installments over 24 months – 6-month increments.

Job Overview

Implement and maintain compliance programs in accordance with the Office of Inspector General’s work plan to reduce institutional and individual provider legal and financial risk through education and internal audits.

Work Performed

• Educate providers regarding compliance with government regulations, especially Center for Medicare and Medicaid Guidelines, HIPAA, and fraud & abuse, with periodic updates.
• Assist in analyzing current situations and recommend priorities and goals for future clinic needs.
• Identify coding and billing risk areas, conduct focused reviews, and implement corrective action as needed.
• Conduct routine internal audits of provider documentation on a timely basis.
• Collaborate with physicians and internal staff to develop improved documentation, coding, and compliance capabilities.
• Review internal controls, policies, and procedures for compliance with university, state, and federal guidelines and sound business and finance practices.
• Respond promptly to external and internal concerns and implement corrective actions as appropriate.
• Communicate with Medicare/Medicaid carriers and third‑party payers regarding policies and procedures.
• Promote compliance initiatives with clinical faculty and administration.
• Perform other related duties incidental to the work described herein.

Knowledge, Skills and Abilities

Same as the Work Performed responsibilities, requiring comprehensive knowledge of Medicare/Medicaid guidelines, coding and billing risk, audit processes, and effective communication with providers and payers.

Experience

Four years of administrative experience applying compliance, coding and auditing principles related to insurance billing, collections, consulting, and revenue cycle functions. Two of those years must involve DRGs and APR‑DRGs. Formal or informal teaching experience in coding is preferred.

Certifications

• RHIA or RHIT or CCS required.
• For professional coding, specialty coding experience in surgical or E/M coding preferred.
• CPC or CCS or RHIT or RHIA or CPMA required.

Minimum Qualifications

Completion of a Bachelor’s degree program. Ability to organize, analyze, and communicate complex information.

Essential Physical Job Functions

Detailed information on physical and/or mental abilities and reasonable accommodation requests will be provided by the hiring department.

Equal Opportunity Employer

Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status.

Diversity Statement

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Read more about Duke’s commitment to affirmative action and nondiscrimination at hr.duke.edu/eeo.