Medical Billing, Coding, and Compliance Specialist

Medical Billing, Coding, and Compliance Specialist Employment Type: Full-time Reports To: Vice President of Growth and Business Development / Executive Leadership Position Overview KollectMD is seeking an experienced Medical Billing, Coding, and Compliance Specialist to help ensure the highest standards of billing accuracy, regulatory compliance, coding integrity, and operational excellence across our growing revenue cycle management organization. This position is ideal for an experienced medical billing and coding professional with a strong background in compliance, documentation review, payer regulations, and audit preparedness. The successful candidate will work closely with leadership and operations teams to improve billing quality, reduce compliance risk, support physician practices, and establish standardized processes as the company continues to expand nationally. Key Responsibilities 1.Billing and Coding Compliance - Review medical claims for coding accuracy and regulatory compliance. - Ensure appropriate application of CPT, HCPCS, and ICD-10 coding guidelines. - Monitor payer policies and reimbursement requirements. - Identify billing errors, coding inconsistencies, and documentation deficiencies. - Recommend corrective actions and process improvements. 2.Internal Auditing - Conduct routine internal audits of coding, billing, and documentation. - Review provider documentation to ensure compliance with federal regulations and payer requirements. - Identify trends that may expose clients or the company to financial or regulatory risk. - Prepare written audit findings and corrective action recommendations. - Monitor implementation of corrective actions. 3.Regulatory Compliance - Maintain current knowledge of CMS regulations, Medicare policies, commercial payer requirements, and industry best practices. - Assist in developing and maintaining company compliance policies and procedures. - Support internal compliance reviews and external audits. - Help maintain documentation required for regulatory and payer compliance. - Assist leadership in responding to payer inquiries or audit requests. 4.Education and Training - Develop educational materials related to coding, billing, and compliance. - Train billing personnel on regulatory updates and coding changes. - Provide guidance regarding documentation improvement opportunities. - Assist in onboarding new billing personnel. - Promote a culture of continuous compliance and quality improvement. 5.Quality Improvement - Monitor key quality indicators related to billing accuracy and reimbursement. - Recommend workflow improvements that increase efficiency while maintaining compliance. - Work with operations leadership to standardize billing procedures across clients. - Assist with implementation of best practices throughout the organization. 6.Collaboration - Work closely with billing teams, coders, practice staff, and executive leadership. - Provide subject matter expertise on complex coding and compliance issues. - Support business development and client onboarding by evaluating billing processes and identifying operational improvements. - Assist with special projects as the organization grows. Required Qualifications - Minimum of 5 years of experience in medical billing, coding, compliance, or healthcare revenue cycle management. - Strong working knowledge of CPT, ICD-10-CM, HCPCS, Medicare, Medicaid, and commercial payer guidelines. - Experience conducting coding or billing audits. - Thorough understanding of healthcare documentation requirements. - Knowledge of revenue cycle management processes from charge entry through collections. - Excellent analytical, organizational, and written communication skills. - Ability to identify operational risks and recommend practical solutions. - High attention to detail and commitment to accuracy. Preferred Qualifications - CPC (Certified Professional Coder), CCS, CPMA, CPCO, RHIT, RHIA, or similar professional certification. - Experience working with multispecialty physician practices. - Experience supporting independent physician groups or large medical organizations. - Familiarity with healthcare compliance programs and internal auditing. - Experience with electronic health record systems and practice management software. - Experience working for a healthcare revenue cycle management company. Leadership Profile The ideal candidate is: - Highly detail-oriented and analytical. - Passionate about regulatory compliance and billing accuracy. - Comfortable interpreting complex payer and regulatory guidance. - Able to educate and mentor billing staff. - Collaborative and solutions-focused. - Committed to maintaining the highest ethical and professional standards. Initial Priorities During the first six months, the selected candidate will: - Evaluate existing billing and coding workflows. - Establish routine coding and compliance audit procedures. - Develop standardized compliance documentation and reporting. - Create training materials for billing staff. - Identify opportunities to improve reimbursement accuracy and reduce compliance risk. - Support the company's continued national growth by strengthening its compliance infrastructure. Compensation Compensation will be competitive and based on experience, certifications, and demonstrated expertise in healthcare billing, coding, and compliance. Application Requirements Qualified candidates should submit: - Current résumé or curriculum vitae. - Summary of experience in medical billing, coding, and compliance. - List of relevant certifications. - Description of audit, compliance, or quality improvement experience. - Current location, availability, and compensation expectations.