Senior Coding Compliance & Claims Integrity Lead

Quartz Health Solutions; Wisconsin; Remote; USD 57,000 - 71,000; Full time

Benefits offered by this job

Professional development opportunities

Robust benefits package

Remote work from home

Job summary

Quartz Health Solutions seeks a Senior Coding Compliance Specialist to ensure accurate, compliant medical coding and high-quality claims processing. You will apply regulatory guidelines, investigate complex claims, and collaborate across teams to strengthen payment integrity.

Responsibilities include analyzing billing patterns, resolving appeals, and educating internal/external partners. A CPC/COC/RHIT/RHIA/CCA/CCS certification is preferred, with a strong foundation in CPT/HCPCS/ICD-10 coding

Qualifications

• Associate degree or higher in medical coding or equivalent experience.
• 5+ years of medical coding experience; CPC/COC/RHIT/RHIA/CCA/CCS certs valued.
• Strong knowledge of CPT, HCPCS, ICD-10, OPPS, IPPS, DRGs.
• Experience with Epic and/or Optum claims edit systems.
• Familiarity with HIPAA and governmental payment policies.

Responsibilities

• Research and validate business decisions and system rationales; educate providers and leadership.
• Analyze billing and coding patterns; identify high-risk practices.
• Review and resolve appeals; collaborate with Clinical Services as needed.
• Respond to customer inquiries with coding expertise.
• Review and adjudicate pendings in systems; ensure coding compliance.
• Collaborate with multi-disciplinary teams to ensure accuracy.
• Conduct data analyses and reporting on claim edits, denials, and insights.

Skills

Medical coding

Regulatory knowledge

Data analysis

Communication

MS Office

Education

Associate’s degree in medical coding

High school equivalency with 8+ years of medical coding experience

Tools

Epic

Optum claims edit

Job description

Quartz Health Solutions seeks a Senior Coding Compliance Specialist to ensure accurate, compliant medical coding and high-quality claims processing. You will apply regulatory guidelines, investigate complex claims, and collaborate across teams to strengthen payment integrity.

Responsibilities include analyzing billing patterns, resolving appeals, and educating internal/external partners. A CPC/COC/RHIT/RHIA/CCA/CCS certification is preferred, with a strong foundation in CPT/HCPCS/ICD-10 coding