(Senior) Coding Compliance Specialist

Overview

We’re seeking a skilled coding professional to support accurate, compliant, and high-quality claims processing across Quartz. This role may be filled at the Coding Specialist or Senior Coding Specialist level, depending on experience. You’ll play a key role in applying regulatory coding guidance, resolving complex claims and appeals, analyzing billing trends, and collaborating across teams to strengthen payment integrity and reimbursement accuracy. 

 

This position offers hands-on work for experienced coders as well as expanded leadership and subject-matter expertise opportunities for senior-level professionals. 

Benefits: 

• Collaborate with a team that respects and values your coding expertise 

• Access professional development opportunities to support your long-term growth 

• Starting pay range based upon skills and experience: $50,900 to $69,200 

+ robust benefits package 

Responsibilities

• Review and apply regulatory coding guidelines to ensure accurate and compliant claims processing 

• Investigate and resolve coding and claims issues, escalating complex matters as appropriate 

• Review, edit, and adjudicate pended or denied claims in HealthLink (Epic) using Claim Edit Software (CES), regulatory guidance, and internal policies 

• Research and resolve coding-related appeals by reviewing medical documentation and collaborating with Medical Directors, Pharmacy, and Medical Management 

• Analyze billing and coding data to identify trends, outliers, and potential high-risk billing practices 

• Conduct data analysis and reporting to support claim edits, denial trends, and leadership insights 

• Respond to coding-related inquiries from providers, members, and internal teams through ServiceNow and CRM platforms 

• Develop and deliver coding education and training for providers, leadership, and internal teams 

• Collaborate with cross-functional teams—including Payment Integrity, Medical Management, SIU, Contracting, Benefits, Customer Success, Marketing, and Provider Reimbursement Configuration—to ensure coding compliance 

• Stay current on industry trends, regulatory updates, and coding best practices 

Additional Responsibilities for Senior-Level Candidates 

• Lead the implementation and oversight of regulatory coding guidelines and complex coding initiatives 

• Serve as a subject matter expert (SME) for high-risk or complex coding scenarios 

• Research, validate, and optimize claim edit logic, business rules, and system configurations; test outcomes and guide improvements 

• Partner with the Special Investigation Unit (SIU) to identify, investigate, and address aberrant billing practices and patterns 

• Lead or significantly contribute to coding policy, procedure, and claim edit strategy development 

• Drive strategy for coding education, provider communication, and internal training initiatives 

• Mentor and support mid-level team members and provide guidance on complex coding decisions 

Qualifications

• Coding Specialist: 

• • High School Equivalency & 1 Year of Relevant Experience  

• • Completion of a Medical Coding Program 

• • Certifications in CPC, COC, RHIT, RHIA, CCA, and/or CCS 

• Senior Coding Specialist: 

• • Bachelor’s degree with 2 years of relevant experience 

                   Or

• • Associate’s degree with 5 years of relevant experience                                                                              

                   Or 

• • High School Equivalency with 8 years of relevant experience 

• • Completion of a Medical Coding Program 

• • Certifications in CPC, COC, RHIT, RHIA, CCA, and/or CCS 

Hardware and equipment will be provided by the company, but candidates must have access to high-speed, non-satellite Internet to successfully work from home. 

  

We offer an excellent benefit and compensation package, opportunity for career advancement and a professional culture built on the foundations of Respect, Responsibility, Resourcefulne