Compliance Educator – Medical and Surgical Oncology

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Title: Compliance Educator – Medical and Surgical Oncology

Hub Locations: Alpharetta, GA; Columbus, OH; Dallas, TX

Remote/Onsite/Hybrid: Remote position

Position Summary

The Compliance Educator – Medical and Surgical Oncology is primarily responsible for delivering targeted compliance, coding, and billing education and executing coding and billing audits across the US Oncology Network, with a specific focus on medical oncology and surgical oncology services. This role applies advanced knowledge of oncology reimbursement, federal and state payer requirements, and documentation standards across professional and facility settings to assess compliance risk, validate billing accuracy, and drive sustainable improvement through education.

The position balances education delivery and audit execution (approximately 70% education / 30% audit) and partners closely with medical and surgical oncology providers, coding professionals, billing operations, and Compliance leadership. The role supports and operates in alignment with the US Oncology Compliance Program, the McKesson Code of Ethics, and Business Standards.

Key Responsibilities

• Deliver targeted, audit-driven education to providers, clinical staff, and billing teams through one-on-one sessions, group education, and collaborative calls.
• Conduct comprehensive coding and billing audits in accordance with Compliance & Ethics standard operating procedures and federal payer guidance.
• Prepare reports of findings and recommendations as well as education summaries for improvement for internal review and distribution to business leaders.
• Translate complex coding and billing requirements into clear, practical guidance for operational and clinical audiences.
• Develop and maintain coding tools, job aids, and reference materials to support compliant documentation and billing practices.
• Respond to billing and coding inquiries submitted through the Ask the Expert (Salesforce) platform within established service-level expectations.
• Review medical record documentation to assess compliance with E/M, CPT, HCPCS, and ICD-10-CM coding requirements and reimbursement rules.
• Validate provider-selected codes for Medicare, Medicaid, and other government and commercial payers.
• Clearly document audit results, required corrections, and supporting evidence, citing medical record documentation and regulatory or payer authority.
• Prepare audit reports, executive summaries, and trend analyses for Compliance leadership and business stakeholders.

Monitoring & Program Support

• Maintain current knowledge of federal and state regulations, CMS guidance, payer policies, and oncology-specific billing requirements.
• Monitor regulatory changes and emerging risk areas and provide timely education and guidance to the Network.
• Support Compliance leadership with data, insights, and recommendations related to audit outcomes, education effectiveness, and risk mitigation.
• Perform additional duties as assigned in support of Compliance & Ethics program objectives.

Minimum Qualifications

• Experience:
  • 7+ years of cumulative healthcare coding and billing education and audit experience.
  • 4+ years of oncology direct coding experience using CPT, HCPCS, ICD-10-CM, and E/M guidelines.
• Certifications (Required):
  • Active CPC, COC, or ROCC certification.
• Certifications (Preferred):
  • CPMA, CCS-P, or CRC.
• Bachelor’s degree in HIM, healthcare administration, or related field preferred

Critical Skills & Competencies

• Strong understanding of federal payer regulations, reimbursement methodologies, and oncology documentation standards.
• Proficiency with Microsoft Office tools (Excel, PowerPoint), Smartsheet, and emerging AI tools (e.g., Copilot)
• Proven ability to communicate complex regulatory and coding concepts clearly and effectively to diverse audiences.
• Ability to manage multiple priorities, meet deadlines, and work effectively in a matrixed env