Compliance Analyst (medical coding audit & documentation)

The Compliance Analyst will report to the Supervisor of Compliance & Privacy Operations and will primarily conduct research and analyze large datasets from various sources to prevent fraud, waste, and abuse. The Compliance Analyst will conduct reviews and assessments across multiple service lines to ensure adherence to state and federal regulations. This position is on the Sound Compliance team and will serve as a liaison, assisting with communication with other Central Services departments, such as Revenue Cycle Management and Legal. This role serves as a liaison between the hospital and Sound remote colleagues to mitigate risk, including preventing inappropriate PHI disclosure, addressing other HIPAA violations, responding to regulators, and communicating with vendors. The Compliance Analyst will work with the Supervisor of Compliance & Privacy Operations to draft annual compliance education based on current state laws and federal regulations. Sound Physicians contracts with over 250 individual hospitals. This position is both client-facing and colleague-facing. This position ensures compliance with Federal and State laws, that Sound functions within the confines of each Business Associate Agreement (BAA), and that all contractual and regulatory obligations are met. Essential Functions / Responsibilities

• Demonstrates the ability to communicate effectively regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific information.
• Use relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards.
• The ability to absorb information and form general rules or conclusions (including finding relationships among seemingly unrelated events) and apply general rules to specific problems to produce answers that make sense
• Research and respond to compliance inquiries, draft responses to reporters, and regulators as required.
• Work closely with the Supervisor of Compliance & Privacy Operations on Risk Assessments.
• The ability to draft documents for the implementation of internal controls, compliance policies, and procedures.
• Reviewing and assessing potential fraud activity and developing fraud detection tools.
• Audits medical record documentation to identify coding variances; prepares reports of findings. Prepares reports in accordance with the Compliance Programs and develops a plan for next steps.
• Acts as a liaison and/or facilitates communication with other central service teams.
• Maintains clear and consistent communication
• Monitors system outputs for integrity and error identification and reports all errors to management.
• Perform problem resolution, including analysis and troubleshooting.
• Project Management skills required to maintain organization and report out weekly to management on the status of current projects.
• Maintains strict confidentiality with regard to protected health information and understands and adheres to Sound’s HIPAA Privacy & Security policies and procedures.
• The ability to educate staff and management on compliance requirements and changes.

Education / Experience: Required:

• High school Diploma or GED certificate
• Coding Certification required (Any of CPC, CPC-H, CCS, CCS-P)
• Experience using compliance management software, such as GRC, or data security is a plus
• At least one year of experience coding Evaluation and Management services
• Ability to clearly communicate medical coding information
• Knowledge of auditing concepts and principles
• Skills in research, auditing, risk assessment, and communication
• Knowledge and understanding of professional fee coding (CPT and ICD-10), physician group practice revenue cycle processes, regulatory compliance issues related to billing and coding, documentation standards, and third-party payer processes
• Experience in related roles like auditing, risk management, or operations provides a strong foundation, with specific industry knowledge (e.g., HIPAA in healthcare, AML in finance)
• Strong written and verbal communication and interpersonal skills
• Ability to use independent judgment and to manage and impart confidential information.
• Ability to adapt, modify, and prioritize audit functions as required

Knowledge, Skills, Abilities:

• Excellent analytical and critical-thinking skills
• Excellent organizational skills
• Excellent written and oral communication skills
• Strong interpersonal skills
• Creative and persistent problem solver
• Client service-oriented (both internal and external)
• Ability to multitask and prioritize workload in a fast-paced environment
• Recent experience with revenue cycle preferred
• Recent experience with project management preferred

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