What are the responsibilities and job description for the Coding Compliance Specialist position at Prairie Lakes Healthcare System?
Coding Compliance Specialist
Job Summary
Join our team and be a part of our mission to deliver accessible, high-quality, affordable, and compassionate healthcare. Prairie Lakes Healthcare System is an independent, non-profit healthcare system serving 10 counties in northeastern South Dakota and west-central Minnesota. Our team at Prairie Lakes makes a difference in the lives of patients and their loved ones
Position Summary
- Full-time (1.0Status) position.
- Hybrid schedule with a mix of remote work and onsite visits to provider locations.
The Coding Compliance Specialist strengthens coding accuracy, documentation quality, and regulatory compliance through data-driven education, audits, and cross-functional collaboration. This role analyzes coding trends, delivers targeted provider and coder education, drives process improvements, and serves as a subject matter expert on payer and regulatory requirements.
Key Responsibilities
- Data-driven education & reporting: Analyze coding audits and documentation trends; prepare reports and presentations using Excel and Power Bl; track outcomes and recommend adjustments.
- Provider and coder education: Develop and facilitate both onsite and virtual training programs; design competency-based curricula, instructional tip sheets, and SmartText templates; and ensure accurate maintenance of training records to support regulatory compliance. Conduct monthly departmental meetings with coding professionals and clinical providers to promote alignment and continuous education.
- Auditing & compliance: Perform routine and targeted audits of medical records and billing; verify coding accuracy against documentation and payer rules; document findings and follow up with corrective actions.
- Collaboration & communication: Partner with provider-facing teams, compliance, revenue cycle, and clinical leadership to improve workflows; communicate coding updates, payer-specific requirements, and regulatory changes.
- Risk management & process improvement: Identify and remediate coding/billing errors to reduce fraud, denials, and financial risk; recommend and champion process changes that increase accuracy and efficiency.
- Subject matter expertise: Serve as internal resource for lCD-10, CPT, HCPCS, Medicare/Medicaid, and risk-adjustment coding questions; support complex case reviews and appeals when needed.
- Charge Description Master: Oversee the maintenance of the Charge Description Master (COM), ensuring timely updates to pricing and coding in accordance with regulatory and organizational standards. Generate patient-specific price estimates and collaborate closely with Patient Access and Business Office teams to support financial transparency and operational efficiency.
Required Qualifications
- Certification: CPC, CPMA, CCA, CCS (AAPC and/or AHIMA core credentialed)
- Experience: Minimum 3 years of experience in medical coding education, auditing, or compliance; at least 2 years coding/billing experience preferred.
- Technical skills: Proficiency with ICD- I 0-CM, CPT, HCPCS; experience with coding audit tools and payer documentation.
- Analytics: Strong Excel skills; experience or comfort with Power BI or similar reporting tools.
- Communication: Proven presentation and group-education skills; ability to translate
complex rules into actionable guidance.
Preferred Qualifications
- Education: Bachelor's degree in health information management, healthcare
administration, or related field.
- Advanced certifications: CCS, CCDS, CRC (Certified Risk Adjustment Coder), or similar.
- Clinical experience: Direct experience working with providers and clinical
documentation improvement initiatives.
- Technical: Advanced Microsoft Office skills and experience with electronic health
record (EHR) systems.
- Logistics: Valid driver's license and reliable transportation for onsite education visits.
Benefits
Prairie Lakes Healthcare System offers comprehensive benefits for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 403(b)-retirement plan, and generous paid time off to maintain a healthy home-work balance.
Additional benefits for those qualifying include:
- Flexible Spending Account
- Employee Assistance Program for mental health
- Education Loan Program
- Community discounts including the Prairie Lakes Wellness Center
Prairie Lakes Healthcare System has a Drug Free Workplace Policy. An accepted offer will require positive reference checks and pre-employment background screening as a condition of employment.