Compliance Coordinator

Role Overview

• Helps ensure our services meet the highest standards of compliance with government and commercial payer requirements
• Audit medical documentation supporting claims billed to government and commercial payers
• Review documentation for accuracy, completeness, and alignment with payer guidelines
• Analyze payer contracts, fee schedules, databases, and system set-up requirements
• Identify audit trends, variances, deficiencies, and potential compliance risks
• Prepare clear audit reports and communicate findings to appropriate stakeholders
• Conduct follow-up audits to confirm corrective actions have been completed
• Assist with development and maintenance of compliance policies, procedures, audit standards, and reports
• Serve as a resource for billing, reimbursement, documentation, and coding-related questions
• Stay current with Medicare, Medicaid, and commercial payer rules and regulations
• Partner with internal teams to resolve billing and documentation concerns
• Prepare and deliver training related to supported billing and documentation expectations

Requirements

• Bachelors degree preferred, or equivalent combination of education, training, and related experience
• 12 years of experience in healthcare compliance, billing, reimbursement, auditing, documentation review, revenue cycle, DME, home care, or a related healthcare setting preferred
• Healthcare compliance or audit experience
• DME, home infusion, respiratory, pharmacy, or pediatric healthcare experience
• Advanced Excel skills
• Experience reviewing documentation for medical necessity and payer compliance
• Knowledge of Medicare and Medicaid regulations
• Experience preparing audit findings, corrective action summaries, or training materials
• Strong understanding of medical documentation, payer requirements, billing support, and compliance standards
• Ability to read, interpret, and apply payer guidelines, contracts, fee schedules, policies, procedures, and governmental regulations
• Strong analytical skills with the ability to identify patterns, trends, variances, and compliance risks
• Excellent attention to detail and ability to manage multiple audits, reports, and follow-up items
• Strong written and verbal communication skills, including the ability to present findings clearly to leadership and internal teams
• Proficiency with Microsoft Excel; advanced Excel skills strongly preferred
• Experience with database maintenance, reporting, or system audits preferred
• Knowledge of Medicare, Medicaid, third-party payer reimbursement, coding, and documentation requirements preferred
• Ability to work independently, problem-solve, and partner cross-functionally with billing, operations, reimbursement, and compliance teams

Benefits

• Holiday Pay
• Paid Time Off
• Health and Dental insurance
• Short & Long-Term Disability and Life Insurance
• 401K with match & educational benefits