Senior Coding Compliance Specialist

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 is seeking a skilled coding professional to support accurate, compliant, and high-quality claims processing as a Senior Coding Compliance Specialist. This position will apply regulatory coding guidance, resolving complex claims and appeals, analyzing billing trends, and collaborating across teams to strengthen payment integrity and reimbursement accuracy.

The Senior Coding Compliance Specialist will investigate, implement, and audit the outcomes of coding and regulatory guidelines. This position will serve as a subject matter expert for coding inquiries from internal and external customers. Come Find your Spark at Quartz!

Benefits

• Collaborate with a team that respects and values your coding expertise
• Access professional development opportunities to support your long-term career growth
• Starting salary based upon skills and experience: $56,600 - $70,600 plus robust benefits package

Responsibilities

• Research and validate business decisions and system rationales to support edits and conduct testing to validate outcomes. Provide education as appropriate to providers and leadership.
• Analyze billing and coding patterns and identify outliers with potentially high-risk practices.
• Review and resolve appeals in system(s) by reviewing medical documentation and making determination. Work with Clinical Services teams as needed to resolve appeal cases.
• Research and respond to customer inquiries and tickets routed for coding expertise.
• Review, edit, and adjudicate claims that are pended and/or assigned in systems.
• Collaborate across multi-disciplinary teams to assure coding compliance.
• Conduct data analysis and reporting to support claim edits, denial trends, and leadership insights.

Qualifications

• Associate’s degree in medical coding with 5+ years of medical coding experiences
• OR high school equivalency with 8+ years of medical coding experience
• Completion of medical coding program
• Certification in CPC, COC, RHIT, RHIA, CCA, and/or CCS
• Strong working knowledge of medical coding, fee and reimbursement mechanisms
• Strong understanding of medical coding and regulatory guidelines, which include- CPT, HCPCS, ICD-10, OPPS, IPPS, DRGs
• Epic healthcare software and/or Optum claims edit system knowledge
• Strong understanding of governmental medical payment policies/regulations and their updates processes
• Knowledge of HIPAA regulations
• Strong analytical and problem-solving skills using critical thinking
• Strong verbal and written communication skills
• Intermediate level of proficiency with Microsoft Office
• Ability to multi-task, prioritize, and manage time wisely
• Self-motivated, ability to work independently to successfully investigate complex issues

Hardware and equipment will be provided by the company, but candidates must have access to high-speed, non-satellite Internet to successfully work from home.

We offer an excellent benefit and compensation package, opportunity for career advancement and a professional culture built on the foundations of Respect, Responsibility, Resourcefulness and Relationships. To support a safe work environment, all employment offers are contingent upon successful completion of a pre-employment criminal background check.

Quartz values and embraces diversity and is proud to be an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity or expression, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified person with disability.