ZipRecruiter

Log In

1

Credentialing Compliance Analyst Jobs (NOW HIRING)

UCLA Health

Compliance Analyst

Los Angeles, CA

$86K - $184K/yr

The Compliance Analyst plays a key role in investigations, compliance reviews, auditing, monitoring ... Bachelor's degree in a related field from an accredited institution or equivalent credentials.

UCLA Health

Compliance Analyst

Los Angeles, CA · On-site

$89K/yr

The Compliance Analyst plays a key role in investigations, compliance reviews, auditing, monitoring ... Bachelor's degree in a related field from an accredited institution or equivalent credentials.

Wellpath

Compliance Analyst

Franklin, TN · On-site

How you make a difference The Compliance Analyst supports the coding compliance and audit program ... Equivalent professional coding credentials and experience may substitute for formal education ...

Provest LLC

Risk & Compliance Analyst

Tampa, FL · On-site

$65K/yr

... complete End-User Credentialing for Data Service Clients. * Assist with the completion of ... Review, analyze, and ensure that the company is compliant with all local, state and federal laws ...

Riverside

Compliance Analyst RMG

Newport, VA · Remote

$57K - $78K/yr

... education, credentials, skills, internal equity, and business needs. FOR APPLICATION REVIEW ... This position serves as subject matter expert to coordinate review and root cause analysis of ...

next page

Showing results 1-20

All JobsCredentialing Compliance Analyst Jobs

Credentialing Compliance Analyst information

See salary details

$15

$25

$43

How much do credentialing compliance analyst jobs pay per hour?

As of Jul 29, 2026, the average hourly pay for credentialing compliance analyst in the United States is $25.42, according to ZipRecruiter salary data. Most workers in this role earn between $18.75 and $27.40 per hour, depending on experience, location, and employer.

What are Credentialing Compliance Analysts?

Credentialing Compliance Analysts are professionals who ensure that healthcare providers and organizations adhere to industry regulations and standards regarding credentials. They review, verify, and monitor the qualifications, licenses, and certifications of healthcare staff to ensure compliance with legal and accreditation requirements. These analysts play a crucial role in minimizing risks, maintaining quality standards, and supporting the integrity of healthcare services. Their responsibilities often include conducting audits, managing documentation, and staying updated on regulatory changes.

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

To thrive as a Credentialing Compliance Analyst, you need a solid understanding of credentialing processes, regulatory standards, and healthcare compliance, often supported by a bachelor’s degree in healthcare administration or a related field. Familiarity with credentialing management software, databases, and knowledge of standards such as NCQA or JCAHO is typically required. Strong attention to detail, analytical thinking, and effective communication skills help ensure accuracy and collaboration across teams. These competencies are vital for maintaining organizational compliance, reducing risk, and ensuring qualified healthcare provider participation.

What is the difference between Credentialing Compliance Analyst vs Credentialing Specialist?

AspectCredentialing Compliance AnalystCredentialing Specialist
Required CredentialsTypically requires a certification in compliance or healthcare administrationOften requires certification in medical billing or credentialing
Work EnvironmentHealthcare organizations, insurance companies, or credentialing firmsHospitals, clinics, or healthcare provider offices
Employer & Industry UsageUsed across healthcare compliance and credentialing departmentsCommonly employed in provider credentialing and onboarding
Search & Comparison IntentOften compared for compliance roles involving regulationsCompared for operational credentialing tasks

The Credentialing Compliance Analyst focuses on ensuring credentialing processes meet regulatory standards and compliance requirements, often involving audits and policy adherence. In contrast, the Credentialing Specialist handles the day-to-day credentialing of healthcare providers, verifying licenses and certifications. Both roles are essential in healthcare credentialing but differ mainly in their focus on compliance versus operational credentialing tasks.

What are the most common challenges faced by Credentialing Compliance Analysts during the provider onboarding process?

Credentialing Compliance Analysts often encounter challenges such as incomplete or inconsistent documentation from providers, tight deadlines to meet regulatory requirements, and frequent updates to compliance standards. Navigating these issues requires strong attention to detail, clear communication with providers and internal teams, and the ability to stay organized under pressure. Collaboration with medical staff, human resources, and legal departments is essential to ensure accurate and timely credentialing, which directly impacts provider readiness and organizational compliance.
More about Credentialing Compliance Analyst jobs
What cities are hiring for Credentialing Compliance Analyst jobs? Cities with the most Credentialing Compliance Analyst job openings:
What states have the most Credentialing Compliance Analyst jobs? States with the most job openings for Credentialing Compliance Analyst jobs include:
What job categories do people searching Credentialing Compliance Analyst jobs look for? The top searched job categories for Credentialing Compliance Analyst jobs are:
Credentialing Compliance Analyst jobs near you
Infographic showing various Credentialing Compliance Analyst job openings in the United States as of July 2026, with employment types broken down into 89% Full Time, 6% Part Time, 1% Temporary, and 4% Contract. Highlights an 83% Physical, 7% Hybrid, and 10% Remote job distribution, with an average salary of $52,870 per year, or $25.4 per hour.

Compliance Analyst

Silicon Valley Medical Development

Los Gatos, CA • On-site

$104K - $114K/yr

Full-time

Re-posted 18 hours ago

Job description

El Camino Health Medical Network is currently seeking a talented Compliance Analyst to join our growing healthcare team!
Pay: $104,000-$114,400 Annually (Exempt)
Location:Los Gatos, CA (Hybrid-Must be Local)
Summary:
The Compliance Analyst monitors and evaluates coding, billing, and documentation practices to ensure alignment with federal and state regulations, payer policies, and internal standards. The role supports risk mitigation, conducts investigations, and partners with clinical and operational teams to improve compliance across the medical network.
Essential Functions:
Regulatory Monitoring and Interpretation
  • Track and interpret regulatory changes affecting professional services, including CMS, OIG, AMA CPT, and commercial payer policies.
  • Assess the impact of new rules on coding, billing, and documentation workflows.
  • Develop guidance and compliance alerts to communicate regulatory updates to stakeholders.

Professional Coding and Billing Compliance Review
  • Conduct internal audits of CPT, HCPCS, and ICD'10'CM coding for professional services across multiple specialties.
  • Review E/M services for correct level selection, time'based coding, and medical decision'making alignment.
  • Evaluate modifier usage, medical necessity, and documentation sufficiency.
  • Identify trends in errors, denials, and potential compliance risks.

Investigations and Risk Mitigation
  • Support investigations related to billing irregularities, payer inquiries, and potential fraud, waste, or abuse.
  • Collaborate with legal, compliance, and revenue cycle teams to develop corrective action plans.
  • Assist in preparing responses to payer audits, including documentation requests and appeals.

Data Analysis and Reporting
  • Analyze coding and billing data to identify patterns, anomalies, and areas of risk.
  • Prepare compliance dashboards, audit summaries, and performance reports for leadership.
  • Monitor key indicators such as denial trends, coding accuracy rates, and audit outcomes.

Compliance Program Support
  • Develop and deliver training on professional fee compliance, COI, Stark, AKS, and general compliance expectations.
  • Maintain documentation of audits, investigations, and corrective actions in accordance with compliance program standards.
  • Support risk assessments, internal reviews, and external audits by providing data, analysis, and subject'matter expertise.
  • Contribute to policy development and updates related to billing, physician arrangements, and organizational compliance.
  • Partner with coders, providers, practice managers, and revenue cycle teams to resolve compliance issues.
  • Support development of policies and procedures related to coding, billing, and documentation compliance.

Minimum Requirements:
  • High School Diploma or equivalent. Bachelor's degree in Business, Healthcare Administration, or similar field preferred.
  • AAPC credentials such as CPC, CPMA, or CPCO.
  • Experience in compliance, auditing, or revenue cycle operations within a physician practice or health system.
  • Familiarity with federal regulations such as Medicare billing rules, OIG guidance, and state'specific requirements.
  • Strong analytical skills with the ability to interpret clinical documentation and billing data.
  • Excellent communication skills, especially in explaining complex regulatory concepts.

Other Knowledge, Skills, and Abilities:
  • Experience with multi'specialty professional coding audits.
  • Background in denial management, payer appeals, and compliance investigations.
  • Knowledge of risk adjustment, quality reporting, and reimbursement methodologies (e.g., RBRVS).
  • Experience developing compliance education or training materials.

The Compliance Analyst monitors and evaluates coding, billing, and documentation practices to ensure alignment with federal and state regulations, payer policies, and internal standards. The role supports risk mitigation, conducts investigations, and partners with clinical and operational teams to improve compliance across the medical network.
Essential Functions:
Regulatory Monitoring and Interpretation
  • Track and interpret regulatory changes affecting professional services, including CMS, OIG, AMA CPT, and commercial payer policies.
  • Assess the impact of new rules on coding, billing, and documentation workflows.
  • Develop guidance and compliance alerts to communicate regulatory updates to stakeholders.

Professional Coding and Billing Compliance Review
  • Conduct internal audits of CPT, HCPCS, and ICD'10'CM coding for professional services across multiple specialties.
  • Review E/M services for correct level selection, time'based coding, and medical decision'making alignment.
  • Evaluate modifier usage, medical necessity, and documentation sufficiency.
  • Identify trends in errors, denials, and potential compliance risks.
    Investigations and Risk Mitigation
  • Support investigations related to billing irregularities, payer inquiries, and potential fraud, waste, or abuse.
  • Collaborate with legal, compliance, and revenue cycle teams to develop corrective action plans.
  • Assist in preparing responses to payer audits, including documentation requests and appeals.
  • Data Analysis and Reporting
  • Analyze coding and billing data to identify patterns, anomalies, and areas of risk.
  • Prepare compliance dashboards, audit summaries, and performance reports for leadership.
  • Monitor key indicators such as denial trends, coding accuracy rates, and audit outcomes.
  • Compliance Program Support
  • Develop and deliver training on professional fee compliance, COI, Stark, AKS, and general compliance expectations.
  • Maintain documentation of audits, investigations, and corrective actions in accordance with compliance program standards.
  • Support risk assessments, internal reviews, and external audits by providing data, analysis, and subject'matter expertise.
  • Contribute to policy development and updates related to billing, physician arrangements, and organizational compliance.
  • Partner with coders, providers, practice managers, and revenue cycle teams to resolve compliance issues.
  • Support development of policies and procedures related to coding, billing, and documentation compliance.

Minimum Requirements:
  • High School Diploma or equivalent. Bachelor's degree in Business, Healthcare Administration, or similar field preferred.
  • AAPC credentials such as CPC, CPMA, or CPCO.
  • Experience in compliance, auditing, or revenue cycle operations within a physician practice or health system.
  • Familiarity with federal regulations such as Medicare billing rules, OIG guidance, and state'specific requirements.
  • Strong analytical skills with the ability to interpret clinical documentation and billing data.
  • Excellent communication skills, especially in explaining complex regulatory concepts.

Other Knowledge, Skills, and Abilities:
  • Experience with multi'specialty professional coding audits.
  • Background in denial management, payer appeals, and compliance investigations.
  • Knowledge of risk adjustment, quality reporting, and reimbursement methodologies (e.g., RBRVS).
  • Experience developing compliance education or training materials.

Apply