Senior Analyst, Compliance COE

We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.

The Senior Analyst, Compliance COE will be a key member of the Compliance Monitoring team and will execute assigned compliance monitoring activities.

Responsibilities

• Execute assigned compliance monitoring activities, applying healthcare compliance, billing, coding, and risk adjustment knowledge.
• Coordinate assigned monitoring activities, including results reporting, issue follow-up, and communication of compliance risks and business impacts.
• Review medical records, claims data, diagnosis codes, modifiers, and supporting documentation to determine whether HCC submissions, RAF impact, billed services, and coding outcomes are accurate, complete, and supported.

Requirements

• 2+ years of experience in healthcare compliance, auditing, monitoring, billing, coding, claims review, medical record review, risk adjustment, investigations, or risk assessments.
• Strong knowledge of CMS Medicare Part B and Part C requirements, Medicare Advantage risk adjustment programs, HCC coding, RAF methodologies, provider documentation standards, medical record validation, coding compliance requirements, and documentation support standards.
• Strong analytical, deductive, problem-solving, and critical thinking skills.
• Willingness to travel up to 5% (including by plane).

Preferred Qualifications

• Demonstrated ability to collaborate across Compliance, Legal, clinical operations, billing, coding, finance, and business teams.
• Ability to facilitate meetings and communicate information clearly in written and verbal form.
• Regular and reliable attendance.
• Perform additional responsibilities as assigned.
• Ability to evaluate information, identify compliance risks, solve complex problems, and recommend practical solutions.

Education

• Bachelor's Degree; equivalent work experience may substitute.
• High School Diploma/GED required.
• Certified Professional Coder (CPC) required.

Benefits

• Comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources.