Compliance Specialist, Healthcare

Join to apply for the COMPLIANCE SPECIALIST role at Duke University Health System
.

At Duke Health, we are driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. Whether your talents lie in clinical work, data analysis, or policy development, you will help us advance health together.

The Patient Revenue Management Organization is Duke Health’s fully integrated, centralized revenue‑cycle team that supports the entire health system in scheduling, registration, coding, billing, and other essential revenue functions.

Implement and maintain compliance programs in accordance with the Office of Inspector General’s work plan, reducing institutional and individual provider legal and financial risk through education and internal audits.

• Educate providers regarding compliance with government regulations, especially CMS guidelines, HIPAA, and Fraud & Abuse.
• Conduct analysis of current situations, recommend priorities, and develop goals for future clinic needs.
• Identify coding and billing risk areas, perform focused reviews, and implement corrective actions.
• Conduct routine internal audits of provider documentation on a timely basis.
• Collaborate with physicians and internal staff to improve documentation, coding, and compliance capabilities.
• Review internal controls, policies, and procedures to ensure compliance with university, state, and federal guidelines and business practices.
• Respond promptly to external and internal concerns; implement corrective actions as appropriate.
• Communicate with Medicare/Medicaid carriers and third‑party payers regarding policies and procedures.

• Strong knowledge of CMS, HIPAA, Fraud & Abuse, and related regulations.
• Ability to educate and audit providers on compliance matters.
• Experience with coding risk assessment and audit processes.
• Excellent communication skills for interacting with physicians, administration, and payers.

Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy‑related conditions), sexual orientation, or military status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. All members of our community have a responsibility to uphold these values.

Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Provision for reasonable accommodation is included.

Bachelor’s degree or equivalent experience.

• Four years of administrative experience applying compliance, coding, and auditing principles in revenue‑cycle functions.
• Specialized experience with DRG and APR‑DRG coding preferred.
• Experience teaching coding concepts preferred.
• RHIA, RHIT, or CCS certification required. CPC, CCS, RHIT, RHIA, or CPMA also acceptable.

Same as Experience section.