Exciting Opportunity at MSK: QA Compliance Specialist I, HIM
At Memorial Sloan Kettering, every role contributes to advancing world-class patient care, research, and operational excellence. As a
QA Compliance Specialist within Health Information Management, you'll ensure the accuracy, integrity, and regulatory compliance of clinical documentation and coding-strengthening revenue integrity, audit readiness, and data quality while supporting MSK's mission to end cancer for life.
Role Overview- Perform compliance reviews and formal audits validating ICD-10-CM/PCS, CPT-4, modifiers, Facility Evaluation & Management, and medication administration coding.
- Ensure accurate coding and charge capture aligned with CMS, third-party payer, JCAHO, and HIPAA regulatory standards.
- Identify documentation gaps, trends, and risks impacting coding and billing accuracy, compliance, and audit outcomes.
- Communicate findings and recommendations to HIM leadership, clinical teams, Revenue Integrity and Patient Accounts partners.
- Coordinate and support external payer audits by preparing documentation and responding to data requests.
- Participate in special projects focused on data management, quality improvement, and process optimization.
- Maintain audit documentation, tracking tools, and reporting to support continuous compliance monitoring.
- Apply independent judgment while operating within defined objectives and regulatory frameworks.
- Promote corrective actions and process enhancements to strengthen coding quality and operational consistency.
- Review and track denials to ensure coding accuracy based on documentation and compliance with regulatory policies and standards.
Key Qualifications - Minimum of 3 years of experience in medical terminology, anatomy and physiology, hospital coding and billing, and medical records.
- Demonstrated expertise with ICD-10-CM/PCS, CPT, and Facility Evaluation & Management coding.
- Hands-on experience conducting coding audits, compliance reviews, and regulatory validation activities.
- Working knowledge of healthcare regulatory requirements, including CMS guidelines and HIPAA standards.
- Proficiency using PC applications such as Microsoft Excel and Word for reporting, analysis, and documentation.
Core Skills - Strong analytical and problem-solving abilities to identify trends, risks, and improvement opportunities in complex data sets.
- Clear, confident communication skills to present findings, provide guidance, and collaborate across multidisciplinary teams.
- High attention to detail and organizational discipline to manage large volumes of sensitive and complex information accurately.
- Ability to navigate multiple clinical, billing, and data systems while adapting to evolving workflows and regulations.
Additional Information: - Location: Hybrid; when on site 633 Third Avenue in NYC (on site 4x a year)
- Schedule: Monday - Friday, 9 am - 5 pm (flexibility to start as early as 6:30 am)
- Reporting to: Manager, Health Information Management
Helpful Links:
- Compensation Philosophy
- Benefits
Pay Range: $69,400.00 - $107,600.00
FSLA Status: Exempt
