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How much do coding compliance specialist jobs pay per hour?

As of Jul 31, 2026, the average hourly pay for coding compliance specialist in the United States is $29.05, according to ZipRecruiter salary data. Most workers in this role earn between $19.23 and $35.10 per hour, depending on experience, location, and employer.

What are some common challenges Coding Compliance Specialists face when ensuring accurate medical coding across teams?

Coding Compliance Specialists often encounter challenges such as keeping up with frequent changes in coding regulations, ensuring all team members consistently apply complex coding guidelines, and addressing discrepancies between clinical documentation and coding requirements. Effective collaboration with providers and coding staff is essential to clarify documentation and resolve issues quickly. Strong attention to detail and ongoing education help specialists maintain compliance and minimize errors, which are crucial for accurate billing and avoiding regulatory penalties.

What Is a Coding Compliance Specialist?

A coding compliance specialist enforces medical billing and coding regulations. As a coding compliance specialist, you are in charge of training medical staff on the different medical codes used in treatment and insurance billing. You also review medical records, clarify billing issues, and conduct audits, while maintaining patient privacy. Medical insurance companies, hospitals, and other healthcare facilities have coding compliance specialists on staff.

What are Coding Compliance Specialists?

Coding Compliance Specialists are healthcare professionals who ensure that medical coding practices within an organization follow all applicable laws, regulations, and guidelines. They review medical records, audit coding processes, and educate staff on proper coding standards to minimize errors and prevent fraud. Their work helps healthcare providers maximize reimbursement while staying compliant with federal and state regulations. By maintaining accurate and ethical coding, they play a crucial role in the financial and legal well-being of healthcare organizations.

What are the key skills and qualifications needed to thrive as a Coding Compliance Specialist, and why are they important?

To thrive as a Coding Compliance Specialist, you need in-depth knowledge of medical coding systems (such as ICD-10, CPT, and HCPCS), healthcare regulations, and a relevant certification like CCS, CPC, or RHIA. Familiarity with electronic health record (EHR) systems and coding audit tools is essential for accurate data analysis and compliance reviews. Strong attention to detail, analytical thinking, and effective communication skills set top performers apart in this role. These competencies are crucial for ensuring coding accuracy, minimizing compliance risks, and supporting proper healthcare reimbursement.

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

AspectCoding Compliance SpecialistMedical Coder
Required CredentialsCertification (e.g., CPC, CCS), knowledge of coding standards, compliance regulationsCertification (e.g., CPC, CCS), proficiency in coding systems
Work EnvironmentHealthcare facilities, compliance departments, insurance companiesHospitals, clinics, physician offices
Employer & Industry UsageFocuses on ensuring coding accuracy and regulatory compliancePrimarily responsible for assigning medical codes for billing
Search & Comparison IntentUnderstanding compliance roles, regulatory standards, auditingMedical coding procedures, billing, and documentation

The main difference is that a Coding Compliance Specialist focuses on ensuring coding practices adhere to regulations and standards, often involving audits and compliance monitoring. In contrast, a Medical Coder primarily assigns medical codes for billing and documentation purposes. Both roles require similar certifications but serve different functions within healthcare organizations.

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Coding Compliance Specialist jobs near you
Infographic showing various Coding Compliance Specialist job openings in the United States as of July 2026, with employment types broken down into 85% Full Time, 11% Part Time, 1% Temporary, and 3% Contract. Highlights an 79% Physical, 4% Hybrid, and 17% Remote job distribution, with an average salary of $60,418 per year, or $29 per hour.

Coding Compliance Specialist

Prestige Billing Services, Ltd.

Miamisburg, OH • Remote

Full-time

Posted 17 hours ago

Posted today

Job description

Position: Coding Compliance Specialist
Reports To: Operations Director
Exempt/Non: Exempt, Full-Time
Education: CPC (Certified Professional Coder) required; CPMA (Certified Professional Medical Auditor) preferred; CCS (Certified Coding Specialist) preferred
Experience: Minimum of five (5) years of physician and/or facility coding experience
The Coding Compliance Specialist is responsible for ensuring coding accuracy, regulatory compliance, and adherence to federal, state, payer, and organizational coding standards. This position serves as the department's subject matter expert for coding compliance by conducting internal and external audits, researching evolving coding regulations, supporting payer audit activities, and developing organizational coding and compliance standards.
This role is a complementary role to the Coding Operations Specialist, which focuses on operational workflow and production. The Coding Compliance Specialist focuses on compliance-related coding review.
In addition to audit responsibilities, the Coding Compliance Specialist leads the research and development of coding and compliance frameworks for prospective clients by evaluating specialty-specific coding requirements, documentation standards, payer regulations, and operational considerations to support successful client onboarding and implementation.
This position is an individual contributor role and does not include direct supervisory or personnel management responsibilities.
Requirements (Skills amp; Background)
  • Demonstrated expertise in coding audits, regulatory compliance, and coding research
  • Thorough knowledge of ICD-10-CM, CPT, HCPCS, CMS regulations, payer policies, and official coding guidelines
  • Strong analytical, research, and problem-solving skills
  • Excellent written and verbal communication skills
  • Proficiency with electronic health records (EHR), coding software, and Microsoft Office application
Essential Duties and ResponsibilitiesCoding Compliance and Auditing
  • Conduct routine internal coding audits to evaluate coding accuracy, documentation quality, and compliance with ICD-10-CM, CPT, HCPCS, CMS, and payer guidelines
  • Review external audit findings and validate recommended corrections prior to releasing encounters from audit hold queues
  • Perform annual coding audits for designated clients to ensure ongoing coding accuracy and regulatory compliance
  • Document audit findings, identify coding and documentation trends, and recommend educational opportunities to improve coding quality
  • Monitor compliance with applicable federal regulations, payer policies, and organizational coding standards
  • Identify compliance risks and recommend corrective actions and process improvements
  • Track audit metrics and prepare audit summaries for leadership review
Regulatory Research and Standards Development
  • Research evolving CMS regulations, payer policies, coding updates, and industry guidance affecting coding and reimbursement
  • Develop, maintain, and update internal coding and compliance policies, standards, reference materials, and best practice guidelines
  • Create and revise coding appeal letter templates, compliance documentation, audit tools, certification letter templates, and supporting resources to promote departmental consistency
  • Translate regulatory changes into practical guidance and educational resources for coding staff
  • Maintain departmental coding reference libraries and compliance resources
  • Help identify payer denials that could be resolved through education of proper coding guidelines
New Client Compliance and Research
  • Research coding, documentation, regulatory, and payer requirements for prospective clients across multiple medical specialties
  • Develop specialty-specific coding and compliance frameworks to support the successful onboarding of new client contracts
  • Evaluate payer requirements, specialty coding guidelines, and documentation expectations to establish compliant operational workflows for new business opportunities
  • Collaborate with operational leadership during the implementation of new client coding processes
  • Assist in developing coding policies, workflows, and documentation standards for newly acquired clients
Audit and Payer Support
  • Collaborate with physicians and providers to prepare certification letters and supporting documentation for payer audits and medical record reviews
  • Support clients with payer coding and contractual issues by researching applicable regulations, identifying coding requirements, and presenting findings to facilitate appropriate resolution
  • Assist with coding-related audit responses, compliance inquiries, regulatory documentation requests, and payer appeals as needed
  • Serve as a coding compliance resource during external audits and client reviews
Coding Consultation and Education
  • Serve as the primary resource for coding staff regarding coding guidelines, compliance issues, payer policies, and documentation requirements
  • Provide coding guidance based on current regulatory standards and official coding references
  • Share audit findings, coding trends, and regulatory updates with the Operations Director to support ongoing education and quality improvement initiatives
  • Assist in developing educational materials and coding reference tools for internal staff
Core Competencies
  • Coding Compliance
  • Medical Coding Auditing
  • Regulatory Research
  • Policy and Standards Development
  • Documentation Review
  • Coding Quality Assurance
  • Critical Thinking
  • Analytical Problem Solving
  • Written and Verbal Communication
  • Collaboration and Consultation
  • Attention to Detail
  • Organization and Time Management
  • Professional Judgment
  • Adaptability
Physical Requirements
  • Ability to sit and work at a computer for extended periods
  • Ability to occasionally lift up to 20 pounds
Additional Responsibilities
  • Maintain confidentiality of protected health information in accordance with HIPAA regulations
  • Maintain required coding certifications and continuing education requirements
  • Participate in departmental meetings, compliance initiatives, and special projects as assigned
  • Support departmental and organizational compliance initiatives
  • Perform other duties as assigned

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