Prairie Lakes Healthcare System
Coding Compliance Specialist
Prairie Lakes Healthcare System, Watertown, South Dakota, United States, 57201
Overview
Prairie Lakes Healthcare System is an independent, non‑profit system serving 10 counties in northeastern South Dakota and west‑central Minnesota. The team delivers accessible, high‑quality, affordable, and compassionate healthcare. Join our mission and make a difference in the lives of patients and their loved ones. Position Summary
Full‑time (1.0 status) hybrid schedule combining remote work and onsite visits to provider locations. This role strengthens coding accuracy, documentation quality, and regulatory compliance through data‑driven education, audits, and cross‑functional collaboration. Key Responsibilities
Data‑driven education & reporting: Analyze coding audits and documentation trends; prepare reports and presentations using Excel and Power BI; track outcomes and recommend adjustments. Provider and coder education: Develop and facilitate onsite and virtual training programs; design competency‑based curricula, instructional tip sheets, and SmartText templates; maintain training records for regulatory compliance; conduct monthly departmental meetings to promote alignment. Auditing & compliance: Perform routine and targeted audits of medical records and billing; verify coding accuracy against documentation and payer rules; document findings and follow up with corrective actions. Collaboration & communication: Partner with provider‑facing teams, compliance, revenue cycle, and clinical leadership to improve workflows; communicate coding updates, payer‑specific requirements, and regulatory changes. Risk management & process improvement: Identify and remediate coding/billing errors to reduce fraud, denials, and financial risk; recommend and champion process changes that increase accuracy and efficiency. Subject matter expertise: Serve as internal resource for ICD‑10, CPT, HCPCS, Medicare/Medicaid, and risk‑adjustment coding questions; support complex case reviews and appeals when needed. Charge Description Master: Oversee maintenance of the Charge Description Master (COM), ensure timely updates to pricing and coding, generate patient‑specific price estimates, and collaborate with Patient Access and Business Office teams for financial transparency and operational efficiency. Required Qualifications
Certification: CPC, CPMA, CCA, CCS (AAPC and/or AHIMA core credentialed). Experience: Minimum 3 years in medical coding education, auditing, or compliance; at least 2 years coding/billing experience preferred. Technical skills: Proficiency with ICD‑10‑CM, CPT, HCPCS; experience with coding audit tools and payer documentation. Analytics: Strong Excel skills; experience with Power BI or similar reporting tools. Communication: Proven presentation and group‑education skills; ability to translate complex rules into actionable guidance. Preferred Qualifications
Bachelor's degree in health information management, healthcare administration, or related field. Advanced certifications: CCS, CCDS, CRC (Certified Risk Adjustment Coder), or similar. Clinical experience: Direct experience working with providers and clinical documentation improvement initiatives. Technical: Advanced Microsoft Office skills and experience with electronic health record (EHR) systems. Logistics: Valid driver's license and reliable transportation for onsite education visits. Benefits
Prairie Lakes Healthcare System offers comprehensive benefits for qualifying full‑time and part‑time employees. Eligible benefits include health, dental, vision, life insurance, a 403(b) retirement plan, and generous paid time off. Additional benefits for qualifying employees include a flexible spending account, employee assistance program for mental health, an education loan program, and community discounts, including access to the Prairie Lakes Wellness Center. Seniority level
Mid‑Senior level Employment type
Full‑time Job function & Industries
Finance and Sales Hospitals and Health Care Prairie Lakes Healthcare System has a Drug Free Workplace Policy. An accepted offer will require positive reference checks and pre‑employment background screening as a condition of employment.
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Prairie Lakes Healthcare System is an independent, non‑profit system serving 10 counties in northeastern South Dakota and west‑central Minnesota. The team delivers accessible, high‑quality, affordable, and compassionate healthcare. Join our mission and make a difference in the lives of patients and their loved ones. Position Summary
Full‑time (1.0 status) hybrid schedule combining remote work and onsite visits to provider locations. This role strengthens coding accuracy, documentation quality, and regulatory compliance through data‑driven education, audits, and cross‑functional collaboration. Key Responsibilities
Data‑driven education & reporting: Analyze coding audits and documentation trends; prepare reports and presentations using Excel and Power BI; track outcomes and recommend adjustments. Provider and coder education: Develop and facilitate onsite and virtual training programs; design competency‑based curricula, instructional tip sheets, and SmartText templates; maintain training records for regulatory compliance; conduct monthly departmental meetings to promote alignment. Auditing & compliance: Perform routine and targeted audits of medical records and billing; verify coding accuracy against documentation and payer rules; document findings and follow up with corrective actions. Collaboration & communication: Partner with provider‑facing teams, compliance, revenue cycle, and clinical leadership to improve workflows; communicate coding updates, payer‑specific requirements, and regulatory changes. Risk management & process improvement: Identify and remediate coding/billing errors to reduce fraud, denials, and financial risk; recommend and champion process changes that increase accuracy and efficiency. Subject matter expertise: Serve as internal resource for ICD‑10, CPT, HCPCS, Medicare/Medicaid, and risk‑adjustment coding questions; support complex case reviews and appeals when needed. Charge Description Master: Oversee maintenance of the Charge Description Master (COM), ensure timely updates to pricing and coding, generate patient‑specific price estimates, and collaborate with Patient Access and Business Office teams for financial transparency and operational efficiency. Required Qualifications
Certification: CPC, CPMA, CCA, CCS (AAPC and/or AHIMA core credentialed). Experience: Minimum 3 years in medical coding education, auditing, or compliance; at least 2 years coding/billing experience preferred. Technical skills: Proficiency with ICD‑10‑CM, CPT, HCPCS; experience with coding audit tools and payer documentation. Analytics: Strong Excel skills; experience with Power BI or similar reporting tools. Communication: Proven presentation and group‑education skills; ability to translate complex rules into actionable guidance. Preferred Qualifications
Bachelor's degree in health information management, healthcare administration, or related field. Advanced certifications: CCS, CCDS, CRC (Certified Risk Adjustment Coder), or similar. Clinical experience: Direct experience working with providers and clinical documentation improvement initiatives. Technical: Advanced Microsoft Office skills and experience with electronic health record (EHR) systems. Logistics: Valid driver's license and reliable transportation for onsite education visits. Benefits
Prairie Lakes Healthcare System offers comprehensive benefits for qualifying full‑time and part‑time employees. Eligible benefits include health, dental, vision, life insurance, a 403(b) retirement plan, and generous paid time off. Additional benefits for qualifying employees include a flexible spending account, employee assistance program for mental health, an education loan program, and community discounts, including access to the Prairie Lakes Wellness Center. Seniority level
Mid‑Senior level Employment type
Full‑time Job function & Industries
Finance and Sales Hospitals and Health Care Prairie Lakes Healthcare System has a Drug Free Workplace Policy. An accepted offer will require positive reference checks and pre‑employment background screening as a condition of employment.
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