Job Details

Senior Billing & Coding Compliance Consultant
Remote Role (Preferred local to Texas)
Remote

ABOUT THE ROLE

Our client is seeking a Senior Billing & Coding Compliance Consultant to serve as a professional billing integrity project leader across all service lines in a 100% remote role, with a preference for candidates local to Texas. This position operates under minimal supervision and is responsible for developing and delivering individual or group presentations and training on coding, billing, and compliance topics, based on new regulatory or industry information, pre-bill review findings, risk areas, or special projects. The consultant will conduct medical record audits, analyze invoices, review internal and external audit findings, and develop and implement quality improvement or corrective action plans. The role includes onboarding and training new providers, performing pre-bill and post-onboarding charge reviews, ensuring compliance with payer and government regulations, and collaborating with the Compliance Office on risk-based audits and education. The consultant will independently review medical documentation, summarize findings, develop action plans for risk mitigation, and provide timely responses to coding and reimbursement policy questions. This role requires strong analytical, communication, and organizational skills, as well as proficiency in Microsoft Office and knowledge of CPT, HCPCS, and ICD-9-CM coding systems.

WHAT YOU’LL DO

• Serve as a billing integrity project leader for all service lines, developing and conducting individual or group presentations on coding, billing, and compliance topics based on regulatory updates, pre-bill review findings, risk areas, or special projects.
• Develop and deliver standardized and specialty-driven coding and compliance training (“onboarding”) for new providers, including physicians, advanced practice providers, and other professional practitioners, ensuring onboarding schedules and processes are current and effective.
• Perform post-onboarding pre-bill reviews of professional charges for any service line, providing feedback and follow-up to confirm understanding of procedure, modifier, and diagnosis code assignment, as well as documentation requirements, to promote billing compliance.
• Assist in ensuring pending charges are reviewed and released in a timely manner according to organizational standards.
• Independently review the adequacy of medical record documentation to support procedure, modifier, and diagnosis coding, identify compliance risks, and develop recommended solutions or action plans, including revised workflows and education.
• Summarize findings and develop action plans for risk mitigation, as requested by leadership or other stakeholders.
• Research and respond to coding, documentation, and reimbursement policy questions or problems submitted by providers, departments, or billing staff, ensuring compliance with payer and government regulations and optimum reimbursement; escalate issues as needed.
• Support and/or conduct risk-based billing compliance audits and provide resulting education in coordination with the Compliance Office.
• Complete charge review and follow-up EPIC work queue assignments for any service line within department timeliness standards, assist in monitoring team work queues, and conduct quality assurance reviews for internal or contractor staff to verify compliance with regulations and guidelines.
• Provide training to new internal or contractor staff on audit software, EPIC, audit plans, and work queue assignments as needed.
• Develop and implement quality improvement or corrective action plans, monitor for intended improvements or necessary alterations, and report progress to Supervisor and/or Manager.
• Perform other duties as assigned to support billing and coding compliance initiatives.

WHAT YOU BRING

• High school diploma or equivalent and six (6) years of experience in a professional billing environment with emphasis on coding, auditing, and/or compliance responsibilities.
• Certification as Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Medical Coder (CMC) required; must obtain Certified Professional Medical Auditor (CPMA) certification within 12 months of hire.
• Strong knowledge of CPT, HCPCS, and ICD-9-CM coding systems, medical record documentation standards, and accepted billing/coding standards.
• Ability to analyze medical records, billing history, payer rules, and other data to validate regulatory compliance and organizational billing integrity.
• Experience developing and conducting coding and compliance training and presentations for individuals and groups.
• Strong verbal and written communication skills, with the ability to interact effectively, professionally, and respectfully with all levels of the organization, including faculty and staff.
• Ability to work independently and collaboratively as a team member to address a variety of complex issues in a timely fashion.
• Proficiency in Microsoft Office (Word, Excel, PowerPoint).
• Detail-oriented with strong organizational and prioritization skills, able to manage a high volume of tasks with follow-through to completion.
• Flexibility to adapt to new processes and procedures and to adjust to the development and refinement of workflows.
• Bachelor’s degree or registered nurse credential desired.