Coding and Compliance Specialist

Employment Type:

Full time

Shift:

Day Shift

Description:

Make an impact on healthcare quality, compliance, and revenue integrity.

Trinity Health Of New England is seeking an experienced Coding Compliance Specialist to support and enhance our Health Information Management (HIM) Compliance Program. This role is responsible for supporting key areas of the organization related to an area of expertise. Uses data, research analysis, critical thinking & problem-solving skills to support colleagues & leadership in achieving organization’s strategic objectives. Serves as a peer influencer & may direct a project or project team by applying industry experience & specialized knowledge.

What You'll Do

• Provides high level technical competency & subject matter expertise analyzing coding and documentation review for professional services, including code selection of evaluation and management codes and procedural services.

• Conducts comprehensive audits of professional coders and providers to ensure accuracy, compliance, and alignment with CPT, ICD 10, HCPCS, HCC and payer specific-specific guidelines.

• Analyze documentation and coding patterns to identify risks related to compliance, revenue integrity, and regulatory requirements.

• Provides clear, actionable feedback to providers, coders, and leadership to improve documentation quality and coding accuracy.

• Maintains current knowledge and credentials through ongoing education and interpretation of regulatory and industry changes.

• Develops and delivers targeted education and training programs based on audit findings, regulatory updates, and identified knowledge gaps.

• Provides training and onboarding to new providers.

• Adheres to coding quality & productivity standards as established by Revenue Excellence; Responsible for completion of audit and education workplan as defined by the Service Area Manager of Coding Audit and Education.

Qualifications

Required

• Associate degree in Health Information Management (HIM), a related field, or an equivalent combination of education and experience.

• Three (3) to Five (5) years of professional coding and/or auditing experience.

• Comprehensive knowledge of ICD-10, HCPCS, CPT, HCC guidelines, medical terminology, Medicare and Medicaid regulations, payer policies, and healthcare compliance standards.

• One of the following certifications is required:

  • Registered Health Information Technician (RHIT)

  • Registered Health Information Administrator (RHIA)

  • Certified Coding Specialist (CCS)

  • Certified Professional Coder (CPC)

Preferred

• Previous coding audit, compliance, or provider education experience.

• Experience identifying documentation and coding improvement opportunities through audits and compliance reviews.

• Strong analytical, communication, and training skills with the ability to educate providers and coding staff.

• Experience working with healthcare coding, electronic medical record (EMR), and auditing systems.

Why Join Trinity Health Of New England?

At Trinity Health Of New England, you'll join a mission-driven healthcare system dedicated to quality, integrity, and exceptional patient care. We offer a collaborative culture, opportunities for professional growth, and the ability to make a meaningful impact across our organization.

Keywords: Coding Compliance Specialist, HIM, Health Information Management, Medical Coding Auditor, Coding Auditor, RHIA, RHIT, CCS, CPC, ICD-10, CPT, Inpatient Coding, Outpatient Coding, Revenue Integrity, Healthcare Compliance, Medical Records, Clinical Documentation.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.