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Coding Compliance Manager Jobs in Rhode Island (NOW HIRING)

Highmark Health

Supervisor Coding

Providence, RI · On-site

$48.54/hr

Assists in the management of daily operational processes, including: optimization of work ... Compliance Requirement : This job adheres to the ethical and legal standards and behavioral ...

Datavant

Profee Coding Consultant - PRN

Providence, RI · On-site

$20 - $28/hr

Conduct data quality reviews of records to assess compliance with official coding and documentation guidelines. * Communicate professionally with co-workers, management, and hospital staff regarding ...

Humana

Inpatient Medical Coding Auditor

Providence, RI · On-site

Ensures overall accuracy and compliance of coding disputes reviews by adhering to all appropriate ... Manages multiple priorities, collaborates with peers and ensures timely completion of inpatient ...

Trice Healthcare

Coding Payment Resolution Spec

Providence, RI · On-site

$19 - $24.25/hr

... and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ... company, managed care organization or other health care financial service setting, performing ...

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Coding Compliance Manager information

What are some common challenges a coding compliance manager faces when implementing new coding guidelines within a healthcare organization?

One common challenge for Coding Compliance Managers is ensuring consistent understanding and adoption of new coding guidelines among diverse coding staff. Differences in experience levels and interpretations can lead to discrepancies, so frequent training and clear documentation are crucial. Additionally, balancing the need for accuracy with productivity targets can be difficult, especially when guidelines change frequently. Effective communication across departments and ongoing audits help address these challenges and promote compliance.

What is a coding compliance manager?

Coding Compliance Managers are professionals responsible for ensuring that healthcare organizations accurately assign medical codes to diagnoses and procedures, and that these codes comply with federal regulations and payer requirements. They oversee coding staff, develop policies, conduct audits, and provide education to ensure proper billing and minimize risks of fraud or non-compliance. Their role is critical for optimizing reimbursement and maintaining the integrity of patient records.

What is the difference between Coding Compliance Manager vs Medical Coder?

AspectCoding Compliance ManagerMedical Coder
CertificationsAHIMA/AAPC certifications, compliance trainingCertified Professional Coder (CPC), CCS
Work EnvironmentHealthcare facilities, compliance departmentsHospitals, clinics, physician offices
Primary FocusEnsuring coding compliance, auditing, policy developmentAssigning medical codes for billing and documentation

The Coding Compliance Manager oversees coding practices to ensure regulatory adherence, while the Medical Coder focuses on accurately translating medical records into codes. Both roles require coding certifications, but the Compliance Manager emphasizes policy, audits, and compliance management, whereas the Medical Coder concentrates on coding accuracy for billing purposes.

What are the key skills and qualifications needed to thrive as a coding compliance manager, and why are they important?

To thrive as a Coding Compliance Manager, you need deep knowledge of medical coding standards (ICD-10, CPT, HCPCS), healthcare regulations, and typically a credential such as CPC, CCS, or RHIA. Familiarity with auditing software, EHR systems, and compliance management tools is crucial. Strong analytical thinking, attention to detail, and effective communication skills set high performers apart. These competencies ensure accurate coding, regulatory compliance, and reduced risk of financial penalties for healthcare organizations.
What are popular job titles related to Coding Compliance Manager jobs in Rhode Island? For Coding Compliance Manager jobs in Rhode Island, the most frequently searched job titles are:
What job categories do people searching Coding Compliance Manager jobs in Rhode Island look for? The top searched job categories for Coding Compliance Manager jobs in Rhode Island are:
What cities in Rhode Island are hiring for Coding Compliance Manager jobs? Cities in Rhode Island with the most Coding Compliance Manager job openings:
Coding Compliance Manager jobs near you
Infographic showing various Coding Compliance Manager job openings in Rhode Island as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution.

Senior Manager, Corporate Compliance - Risk Adjustment

CVS Health

Woonsocket, RI • On-site

$75K - $165K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 19 days ago

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,332 frontline employees who took The Breakroom Quiz

89th of 112 rated pharmacies

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary

As a Senior Manager, Medicare Compliance - Risk Adjustment, you are responsible for overseeing and maintaining compliance with CMS regulations related to Medicare Advantage Risk Adjustment, Hierarchical Condition Categories (HCCs), encounter data submission, documentation and coding compliance, and related regulatory requirements. This position serves as a key compliance leader and subject matter expert, partnering with Risk Adjustment Operations, Coding, Provider Education, Clinical Documentation Improvement (CDI), Internal Audit, Legal, and Government Affairs teams to ensure organizational adherence to CMS requirements.

The ideal candidate possesses extensive experience in Medicare Advantage compliance and a deep understanding of CMS Risk Adjustment methodologies, diagnosis coding requirements, medical record documentation standards, RADV audits, and evolving regulatory guidance.

Key Responsibilities

  • Lead the Medicare Advantage Risk Adjustment compliance program.

  • Monitor and interpret CMS regulations, HPMS memoranda, Final Rules, Medicare Managed Care Manual guidance, RADV requirements, and OIG enforcement activities.

  • Assess operational processes for compliance risks related to risk adjustment activities.

  • Develop and implement corrective action plans for identified compliance issues.

  • Conduct compliance risk assessments related to coding, documentation, and encounter data submissions.


Required Qualifications

  • Minimum 7 years of experience in Medicare Advantage, Risk Adjustment, Coding Compliance, Audit, or Regulatory Compliance

  • Minimum 5 years in a leadership role

  • One or more of the following certifications: CPMA (Certified Professional Medical Auditor), CRC (Certified Risk Adjustment Coder), CPC (Certified Professional Coder), CCS (Certified Coding Specialist)

  • Willingness to travel up to 10% (including by plane)


Preferred Qualifications

  • Health Information Management (RHIA/RHIT)

  • Nursing - Strong understanding of clinical documentation and medical record review

  • Certified Risk Adjustment Coder (CRC) with compliance experience

  • Provider coding audit/compliance leadership experience

  • Medicare Advantage compliance leadership experience supporting RADV, HCC validation, and CMS audits


Education

Bachelor's degree in Health Information Management, Healthcare Administration, Nursing, Public Health, Business Administration, Healthcare Compliance, or a related healthcare field required; equivalent years of work experience may substitue.

Pay Range

The typical pay range for this role is:

$75,400.00 - $165,954.00


This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This fulltime position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial wellbeing of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.


Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 08/12/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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