Job Description
Job Title : Senior Compliance Analyst
Location: St Louis, Missouri
Type: Full Time
Our client is looking for an experienced professional to lead oversight activities, review clinical documentation, and support coding integrity across healthcare operations.
What You’ll Do
- Execute oversight of risk adjustment activities, including monitoring, auditing, and supporting first-line quality checks.
- Review medical records to validate accurate diagnosis coding aligned with Hierarchical Condition Categories (HCCs) and other risk adjustment models.
- Identify documentation gaps, assess risk levels, and communicate findings to stakeholders to maintain data integrity.
- Collaborate with coding teams to improve documentation practices and ensure compliance with regulatory and industry standards.
- Apply ICD-10, AHIMA guidelines, Coding Clinic references, and organizational policies to ensure accurate and compliant coding.
- Validate clinical documentation for risk adjustment coding appropriateness and relevance.
- Provide expert guidance on CMS coding requirements, clinical documentation improvement (CDI), and best practices.
- Conduct gap analyses, recommend remediation strategies, and support corrective action planning for compliance issues.
- Perform clinical chart reviews and advise on best practices for HCC capture and documentation improvement.
Education & Experience
- High School Diploma or GED required; Bachelor’s degree in Nursing, Healthcare Management, or related field preferred.
- 5+ years of professional coding experience in hospital or physician settings.
- Managed care experience preferred.
Licenses & Certifications
- LVN, LPN, or RN required.
- Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) required.
- Certified Risk Adjustment Coder (CRC) preferred.
- NP or PA certification a plus.
Benefits
- Competitive Pay
- Comprehensive Health Insurance
- 401(k) Plan & Employee Stock Purchase Options
- Tuition Reimbursement
- Paid Time Off + Holidays
- Flexible Work Options – Remote, Hybrid, Field, or Office