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Medical Compliance Jobs (NOW HIRING)

St Mary Medical Center

Billing Rep

Long Beach, CA · On-site

$25.66 - $30.50/hr

Knowledge of Medicare and Medical compliance and documentation standards for billing, CPT and ICD-9 coding, including Physician Guidelines, medical terminology, anatomy and disease processes ...

MIDWEST RKP LLC

Registered Nurse

Saint Paul, MN · On-site

Communicate to the medical compliance team any issues or adverse effects clients experience. * Provide therapeutic communication along with exceptional customer service * Assist staff with store ...

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Medical Compliance information

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$31.5K

$98.9K

$207.5K

How much do medical compliance jobs pay per year?

As of Aug 16, 2026, the average yearly pay for medical compliance in the United States is $98,949.00, according to ZipRecruiter salary data. Most workers in this role earn between $61,500.00 and $115,000.00 per year, depending on experience, location, and employer.

What are some common challenges faced by professionals in medical compliance roles, and how can they be addressed?

Medical compliance professionals often face the challenge of keeping up with constantly changing regulations and ensuring that all staff adhere to updated policies. Staying informed through ongoing education and participating in professional networks can help mitigate this challenge. Additionally, fostering open communication with clinical teams and regularly conducting internal audits can ensure compliance is maintained and issues are addressed proactively. Building strong relationships with regulatory bodies and leveraging compliance management software also aids in streamlining daily responsibilities.

What is the difference between Medical Compliance vs Medical Coding?

AspectMedical ComplianceMedical Coding
Required CredentialsCertifications like CHC, CHPC, or HIPAA certificationsCertified Professional Coder (CPC), Certified Coding Specialist (CCS)
Work EnvironmentHealthcare facilities, compliance departments, regulatory agenciesHospitals, clinics, billing companies
Employer & Industry UsageEnsures healthcare organizations follow laws and regulationsTranslates medical diagnoses and procedures into codes for billing

Medical Compliance focuses on ensuring healthcare organizations adhere to laws and regulations, while Medical Coding involves translating medical information into standardized codes for billing and record-keeping. Both roles are essential in healthcare but serve different functions within the industry.

What is a medical compliance professional?

Medical compliance professionals are responsible for ensuring that healthcare organizations and providers adhere to laws, regulations, and ethical standards related to patient care, billing, privacy, and operational practices. They develop and implement policies, conduct audits, provide staff training, and address compliance issues to minimize legal and regulatory risks. Their work helps maintain the integrity of healthcare organizations and protects patient safety and privacy.

What are the key skills and qualifications needed to thrive as a medical compliance professional?

To thrive as a Medical Compliance professional, you need a thorough understanding of healthcare regulations, compliance frameworks, and risk management, often backed by a degree in healthcare administration or a related field. Familiarity with regulatory databases, audit management software, and certifications such as Certified in Healthcare Compliance (CHC) are commonly required. Exceptional attention to detail, ethical judgment, and strong communication skills are vital for effectively interpreting and enforcing compliance requirements. These skills ensure organizations maintain legal and ethical standards, reducing risk and promoting patient safety.
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What cities are hiring for Medical Compliance jobs?

Cities with the most Medical Compliance job openings:

What states have the most Medical Compliance jobs?

States with the most job openings for Medical Compliance jobs include:

What job categories do people searching Medical Compliance jobs look for?

The top searched job categories for Medical Compliance jobs are:

Medical Compliance jobs near you
Infographic showing various Medical Compliance job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $98,949 per year, or $47.6 per hour.

Medical Compliance Auditor

Texas Children's Hospital

Bellaire, TX

Full-time

Re-posted 26 days ago

Texas Children's Hospital rating

8.3

Company rating: 8.3 out of 10

Based on 175 frontline employees who took The Breakroom Quiz

71st of 1,059 rated hospitals

Job description

We are searching for a Medical Compliance Auditor - someone who works well in a fast-paced setting. In this position, you will review and approve or deny medical claim appeals and perform clinical audits of medical records submitted in support of services billed by providers. This process includes clinical judgment, utilization review, application of product benefits, understanding of regulatory requirements for Medicaid managed care and fraud and abuse, and verification of medical necessity utilizing nationally recognized criteria.

Think you've got what it takes?

Job Duties & Responsibilities 
   Assess the treatment plan, clinical information, and medical necessity of all requested services 
   Utilizes established criteria to appropriately review billed services within established timeframe required. 
   Consults with medical directors and clinical staff regarding patient's history and current care needs and whether services billed were appropriate. 
   Refers case failing medical necessity criteria to the Special Investigations Unit (SIU) Director and SIU Workgroup for review and a recommendation for action. 
   Telephonic follow-up with the provider's office to request additional information as needed. 
   Completes timely entry of information into electronic file including a chart with detailed findings of the review and a report summarizing the results of the audit. 
   Evaluate benefit coverage and regulatory guidelines pertinent to decision making for each investigation. 
   Perform Clinical and Coding Review on Medical Claim Appeals. 
   Assess and process all education and recoupment letters after Special Investigative Committee review decision. 
   Facilitates provider communication and education. 
   Liaisons with internal staff members. 
   Perform Clinical Review and make recommendation on Audit Pass/Fail. 
   Ongoing assessment for quality indicators and concerns.


Skills & Requirements 
    Required Associate's Degree in Nursing  or
    Technical Diploma in Vocation Nursing
    Preferred Bachelor's Degree in Nursing
    Required LVN - Lic- Licensed Vocational Nurses Texas Board of Nursing or Nursing Licensure Compact or 
    RN-Lic-Registered Nurses Texas Board of Nursing or Nursing Licensure Compact 
    Preferred CPC-Cert-Cert Professional Coder Americal Academy of Professional Coders
     Required 3 years Clinical experience in the applicable field according to the license (LVN or RN) 
     4 years of Medical Auditing experience.
 

Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.

To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.

Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

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