Compliance Analyst

🔥 1 hour ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🚔 Compliance

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Wellpath

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 2003

🏥 Healthcare

🏛️ Government

🌍 Social Impact

Healthcare • Government • Social Impact

Wellpath is a healthcare services provider that delivers medical and mental health care to individuals in correctional settings such as jails and prisons across the United States. The company staffs facilities with nursing, behavioral health, physicians, pharmacy, dental, and support professionals, operates a public careers portal, and emphasizes comprehensive employee benefits and hiring integrity. Wellpath partners with government correctional agencies to care for vulnerable, often overlooked populations and promotes community reintegration and social impact through its outreach programs.

📋 Description

• Support the coding compliance and audit program through data collection, analysis, routine coding audits, and report preparation • Conduct entry- to intermediate-level coding reviews for services provided in correctional settings and through third-party billing vendors • Conduct routine coding reviews and audits to ensure accurate CPT, HCPCS, ICD-10-CM, and modifier use • Collect, organize, and validate audit data • Maintain audit workpapers and tracking logs • Prepare monthly, quarterly, and ad hoc compliance reports • Perform data analysis to identify trends and risks • Support vendor audits and compliance efforts by reviewing documentation, comparing claims, and tracking remediation activities • Assist senior auditors and leadership with complex audits, regulatory inquiries, education materials, and education initiatives • Maintain audit tools and documentation • Support efficient audit workflows using available tools

🎯 Requirements

• Completion of a formal coding training program (AAPC, AHIMA, or equivalent) required • Equivalent professional coding credentials and experience may substitute for formal education • Minimum three (3) years of professional medical coding, billing, or coding-audit support experience • Working knowledge of CPT, HCPCS Level II, ICD-10-CM, and modifier guidelines • Experience with EMR systems, encoders, and claims/billing workflows • Familiarity with CMS, OIG, AMA, and payer documentation and coding requirements • Exposure to state Medicaid coding rules, Section 1115 Reentry Demonstration billing requirements, and correctional health workflows required • Certified Professional Coder (CPC) through AAPC required • Associate's degree in Health Information Management, Health Sciences, Business, or a related field preferred • Bachelor's degree preferred • Experience supporting audits or oversight of third-party billing vendors preferred • Previous correctional/detention facility experience preferred • Certified Professional Medical Auditor (CPMA) through AAPC preferred, or to be obtained within the first twelve (12) months of employment • Certified Professional Biller (CPB) through AAPC preferred • Certified Coding Specialist (CCS) through AHIMA may be substituted for an AAPC equivalent • Must reside in the United States

🏖️ Benefits

• Comprehensive medical, dental, and vision benefits • Paid time off • 401(k) • DailyPay • Tuition assistance and dependent scholarships • Employee Assistance Program (EAP) including free counseling and health coaching • Company-paid life insurance • Tax-free Health Spending Accounts (HSA) • Wellness program featuring fitness memberships and product discounts • Preferred banking partnership and discounted rates for home and auto loans • Ongoing training and development opportunities • Excellent career growth opportunities

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